Jaundice and Liver Disease in Pregnancy
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Liver diseases in pregnancy include: those present at conception; those that occur coincidentally; and those that occur as a result of pregnancy. If liver disease is suspected, the most important factor is to determine the gestational age of the pregnancy, as the differential diagnoses change with the stage of the pregnancy. A history of intravenous drug use or alcohol abuse will make certain forms of liver disease much more likely. Abdominal pain, particularly in late pregnancy, may be extremely important as it can be a sign of acute fatty liver, hepatic rupture, or eclampsia, or rather less worrying but more common, gallstones. Jaundice is rare during pregnancy, and has no prognostic importance in terms of the severity of the liver disease. In liver failure, a change in the international normalised ratio or prothrombin time is the most sensitive and rapid indicator of liver synthetic function, and hence liver failure.
Haemostasis
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
Haemostasis is the physiological process that stops bleeding at the site of an injury while maintaining normal blood flow elsewhere in the circulation. There are two main components of haemostasis: primary haemostasis and secondary haemostasis. Primary haemostasis refers to platelet aggregation and platelet plug formation. Secondary haemostasis refers to the deposition of insoluble fibrin generated by the coagulation cascade. Coagulation is a biological amplification system in which a few initial substances activate, by proteolysis, a cascade of circulating precursor enzymes. This results in the generation of thrombin, which converts soluble plasma fibrinogen into fibrin. The common clinical tests of coagulation include prothrombin time, activated partial thromboplastin time and thrombin time. These reflect the in vitro processes which are measured by laboratory tests of coagulation. Fibrinolysis is a process where fibrin and fibrinogen are cleared by plasmin. Plasminogen in blood and tissue fluid is converted to plasmin (a serine protease) by intrinsic activation.
Vitamin K
Howerde E. Sauberlich in Laboratory Tests for the Assessment of Nutritional Status, 2018
Vitamin K is one of the fat-soluble vitamins. A vitamin K deficiency is associated with a prolonged prothrombin time and ecchymoses. Breast-fed infants commonly have a very poor vitamin K status with low plasma prothrombin concentrations. In the human, vitamin K deficiency is often associated with the use of anti-coagulants which inhibit vitamin K epoxide reductase. Traditional methods for assessing vitamin K status, such as prothrombin tests, and activated partial thromboplastin time, are relatively insensitive for detecting a subclincial vitamin K deficiency. Serum vitamin K testing has been suggested for individuals with osteoporosis, or in women who have relatives with osteoporosis. The most common causes of vitamin K deficiency are malnutrition, antibiotic therapy, oral anticoagulants, and infant hemorrhagic disease. The blood clotting process involves the participation of a number of vitamin K dependent plasma proteins.
Swim exercise inhibits hemostatic abnormalities in a rat model of obesity and insulin resistance
Published in Archives of Physiology and Biochemistry, 2019
Mohammad Dallak, Ismaeel Bin-Jaliah, Hussein F. Sakr, Bahjat Al-Ani, Mohamed A. Haidara
Background: We sought to determine whether swim exercise can inhibit high carbohydrate and fat diet (HCFD)-induced biomarkers of coagulation and thrombosis. Material and methods: Rats were either fed with HCFD (model group) or a standard laboratory chow (control group) for 15 weeks. Swim exercise-‘treated’ rats started swim exercise training from the 11th week until being sacrificed, on Week 15. Results: HCFD caused a significant increase in blood glucose, insulin resistance (HOMA-IR), lipidemia, and inflammatory biomarkers. In addition, HCFD significantly modulated coagulation and thrombosis biomarkers; fibrinogen, plasminogen activator inhibitor-1, von Willebrand factor, prothrombin time, activated partial thromboplastin time, blood clotting and bleeding time, and ADP-induced platelet aggregation that was effectively inhibited by swimming exercises. Conclusions: We demonstrate that in an animal model of obesity and insulin resistance, there is a significant change in hemostasis, which is ameliorated by swim exercise.
Detection of mild inherited disorders of blood coagulation: current options and personal recommendations
Published in Expert Review of Hematology, 2015
Giuseppe Lippi, Leonardo Pasalic, Emmanuel J Favaloro
Although assessment of prior personal and familial bleeding history is an important aspect of the diagnosis of bleeding disorders, patients with mild inherited bleeding disorders are sometimes clinically asymptomatic until presented with a hemostatic challenge. However, bleeding may occur after incursion of trauma or surgery, so detection of these conditions reflects an important facet of clinical and laboratory practice. Mild bleeding disorders may be detected as a result of family studies or following identification of abnormal values in first-line screening tests such as activated partial thromboplastin time, prothrombin time, fibrinogen and global platelet function screen testing, such as the platelet function analyzer. Following determination of abnormal screening tests, subsequent investigation should follow a systematic approach that targets specific diagnostic tests, and including factor assays, full platelet function assays and more extensive specialized hemostasis testing. The current report provides a personal overview on inherited disorders of blood coagulation and their detection.
Increased homocysteine plasma level is associated with shortened prothrombin time in HIV-infected patients
Published in HIV Clinical Trials, 2016
Bernardino Roca, Manuel Roca, Guillermo Girones
Objective: To find factors associated with increased homocysteine plasma level in HIV-infected patients. Methods: Cross-sectional study, carried out as a supplementary task to the standard care of HIV-infected patients. The possible association of increased homocysteine plasma level with blood analyses results was assessed with a multiple linear regression analysis, using the automatic linear modeling available in SPSS version 22. Results: A total of 145 patients were included. Creatinine was higher than normal in 7 patients (5%), prothrombin time was shortened in 36 patients (25%), and a monoclonal gammopathy was detected in 2 patients (1%). In the regression analysis, an association was found between high homocysteine plasma level and the following variables: low prothrombin time (β coefficient −0.286, confidence interval −1.1854 to −0.754, p
Related Knowledge Centers
- Fibrinogen
- Prothrombin
- Blood
- Blood Physiological Phenomena
- Tissue Thromboplastin
- Factor Vii
- Coumarins