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Anesthetic management of a chronic liver disease patient with very low platelet counts by considering a rebalanced hemostasis - A case report -
Anesth Pain Med 2018;13(4):419-22
Published online October 31, 2018
© 2018 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Bobae Han, Suk Young Lee, and Gaab-Soo Kim
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Gaab-Soo Kim, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
Tel: 82-2-3410-0360
Fax: 82-2-3410-0361
E-mail: gskim@skku.edu
ORCID
http://orcid.org/0000-0002-9383-2652
Received February 14, 2018; Revised July 12, 2018; Accepted July 13, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The coagulation profile of patients with end-stage liver disease (ESLD) is different from that of healthy individuals. Because hemostasis is rebalanced in chronic liver disease, prophylactic transfusion of blood products may be not necessary for these patients even if they show severe coagulation dysfunction in conventional coagulation results. A 44-year-old man with hepatocellular carcinoma, cholangiocarcinoma and liver cirrhosis was scheduled for extrahepatic mass excision under general anesthesia. His preoperative tests showed severe thrombocytopenia 19 × 109/L. The patient underwent extrahepatic mass excision surgery under general anesthesia without transfusion of blood products. The post-operative course was uneventful without requiring any further hemostatic therapy. In this case report, we focus on the concept of rebalanced hemostasis in ESLD, and coagulation management based on rotational thromboelastometry.
Key Words : Blood coagulation; Blood platelets; Rebalanced hemostasis; Rotational thromboelastometry; Thromboelastography.


October 2018, 13 (4)
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