Abstract
It was well known that a bleeding tendency frequently occurred as a troublesome complication in liver cirrhosis. In this paper, abnormalities of coagulation were studied in 30 cases with liver cirrhosis admitted in St. Luke's Int'l Hospital of Tokyo. Fifteen patients were active cases showing jaundice, ascites or esophageal varices.
Thrombocytopenia(lower than 10×104/mm3) were found in nineteen cases(65.5%), and the drop in platelet count lower than 5×104/mm3 in six patients (20.7%). Since the degree of thrombocytopenia paralled with the weight of spleen, and the megakaryocytes were normal or rather increased in the bone marrow, the chief cause of thrombocytopenia in liver cirrhosis was concluded as hypersplenism.
Factor II, V, VII and X decreased respectively in the frequency of 39.3%, 32.1%, 39.3% and 47.4% of cases. In general, the drop in factor II, V and VII were more striking in the active stage than in other stage. The extent in deficiency of these factors paralled with the decrease of serum albumin. Howerver, factor XIII was normal in all cases. Plasma fibrinolytic activity increased in twenty-two cases(78.6%), and this phenomenon was more strking in active stage than in inactive stage of liver cirrhosis. Furthermore, the degree of increase in fibrinolysis correlated to the elevatin of serum γ-globulin. As platelet functions, clot retraction decreased in seven cases (35%), and adhesiveness reduced in four cases (20%).
Platelet aggregation impaired in fourteen patients (63.6%), and this finding was more prominent in the cases with increased fibrinolytic activities. These results may indicate that the elevated fibrinogen-fibrin degradation product impaired the aggregation of platelet.
But the activity of platelet-3 decreased in only four cases (20%).
From the results presented here, we can conclude that the hemorrhagic tendency occur due to the complex of decreases in platelet number, platelet functions and clotting factors, and increased fibrinolytic activities. However, these results had no relation with the histological type of liver cirrhosis.
