Thromboelastometry-guided hemostatic therapy: an efficacious approach to manage bleeding risk in acute fatty liver of pregnancy: a case reportReport as inadecuate

Thromboelastometry-guided hemostatic therapy: an efficacious approach to manage bleeding risk in acute fatty liver of pregnancy: a case report - Download this document for free, or read online. Document in PDF available to download.

Journal of Medical Case Reports

, 9:202

First Online: 23 September 2015Received: 16 April 2015Accepted: 21 August 2015DOI: 10.1186-s13256-015-0690-9

Cite this article as: Crochemore, T., de Toledo Piza, F.M., Silva, E. et al. J Med Case Reports 2015 9: 202. doi:10.1186-s13256-015-0690-9


IntroductionAcute fatty liver of pregnancy AFLP is a rare but life-threatening disease. AFLP is characterized by liver failure with different degrees of coagulopathy. Outcome and survival can be dramatically improved with prompt recognition and treatment. Thromboelastometry has been considered a point of care for the management of bleeding patients. It could, therefore, be an alternative tool to treat the complex cases of AFLP involving liver failure and coagulopathy. Through this study, we present our successful experience of an AFLP case that was submitted to an emergency cesarean section in which blood transfusion was guided by thromboelastometry.

Case presentationWe report the case of a previously healthy 28-year-old woman, Afro-Brazilian, in her first pregnancy with no medical records until the 36 pregnancy week. She presented to our emergency department with an acute onset of abdominal pain, jaundice, nausea and vomiting. The laboratory examinations revealed metabolic acidosis, acute kidney injury serum creatinine 3.4mg-dL, platelets 97 × 10-mm, serum fibrinogen 98mg-dL and increased international nationalized ratio INR 6.9 without acute bleeding. An emergency cesarean section was indicated. Based on the results of the thromboelastometric tests EXTEM and FIBTEM, prothrombin complex concentrate and fibrinogen concentrate were administered at the beginning of the cesarean section, which succeeded with no major bleeding and without need of further transfusion.

ConclusionsThromboelastometry may be considered a useful, feasible and safe tool to monitor and manage coagulopathy in obstetric patients with acute fatty liver of pregnancy, with the potential advantage of helping avoid unnecessary transfusion in such patients.

AbbreviationsAFLPacute fatty liver of pregnancy

ALPserum alanine aminotransferase

aPTTactivated thromboplastin time

ASTserum aspartate aminotransferase

CFTclot formation time

CTclotting time

FFPfresh frozen plasma

ICUintensive care unit

HELLPhemolysis, elevated liver enzymes and low platelet count

INRinternational nationalized ratio

LCHADlong-chain 3-hydroxyacetyl-coenzyme-A dehydrogenase

LI60lysis index 60

MCFmaximum clot firmness

MLmaximum lysis

PTprothrombin time


TACOtransfusion acute cardiac overload

TRALItransfusion-related acute lung injury

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Author: Tomaz Crochemore - Felipe Maia de Toledo Piza - Eliézer Silva - Thiago Domingos Corrêa


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