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A conceptual and practical approach to haemostasis in paediatric liver disease
  1. Maria Magnusson1,2,3,4,
  2. Vera Ignjatovic3,4,
  3. Winita Hardikar3,5,
  4. Paul Monagle3,4,6
  1. 1CLINTEC, Division of Pediatrics, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
  2. 2MMK, Clinical Chemistry and Blood Coagulation Research, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Paediatrics, University of Melbourne, Melbourne, Australia
  4. 4Haematology Research, Murdoch Childrens Research Institute, Melbourne, Australia
  5. 5Department of Gastroenterology, Royal Children's Hospital, Melbourne, Australia
  6. 6Department of Clinical Haematology, Royal Children's Hospital, Melbourne, Australia
  1. Correspondence to Dr Maria Magnusson, CLINTEC, Division of Pediatrics, MMK, Clinical Chemistry and Blood Coagulation Research, Karolinska Institutet, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Huddinge, Stockholm SE-141 86, Sweden; maria.magnusson{at}ki.se

Abstract

Children with liver disease can develop severe bleeding episodes and thrombosis. Liver failure usually results in decreased levels of procoagulant and anticoagulant factors. Additional risk factors, including changes in vascular flow and endothelial function, are of importance for the development of bleeding or thrombosis in individual vascular beds. Detailed studies of haemostatic disturbances in the setting of paediatric liver disease are sparse and extrapolation from adult studies is common. The spectrum of liver diseases and the haemostatic system differs between children and adults. Specific paediatric liver diseases are reported to have more distinctive effects on haemostasis and the risk of bleeding and/or thrombosis. Conclusion: we propose a model regarding haemostasis in paediatric liver disease, taking into account a number of specific variables and mechanisms, as well as the type of liver disease, which will provide a framework for clinical decision-making in these complex patients.

  • Haematology
  • Hepatology

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