University of Wisconsin–Madison Medical College of Wisconsin

Severe Thrombocytopenia in Decompensated Liver Disease: An Example of Accelerated Intravascular Coagulation and Fibrinolysis

Jesse Fletcher, BA; Brandon J. Calley, BS; Pinky Jha, MD, MPH

WMJ. 2024;123(1):48-50.

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Introduction: Advanced liver disease can present with severe thrombocytopenia that can be difficult to delineate and manage. Here we describe a unique entity of accelerated intravascular coagulation and fibrinolysis (AICF) in a patient with decompensated liver disease.

Case Presentation: A 56-year-old male with a history of alcoholic cirrhosis was admitted for weakness, nausea, metabolic derangement, and acute kidney injury determined to be secondary to decompensated liver disease. During admission, his platelet count declined to <10 000/µL requiring 8 total platelet transfusions. Laboratory and clinical evaluation supported a diagnosis of AICF, and the patient gradually improved with supportive management.

Discussion: AICF can present similarly to disseminated intravascular coagulation, and careful evaluation of specific laboratory values is required for accurate diagnosis. Appropriate management minimizes the associated increased risk of bleeding and prevents delay in procedural intervention.

Conclusions: This case highlights the importance of early clinical and laboratory correlation, multidisciplinary care, and supportive treatment in the management of AICF.

Author Affiliations: Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Fletcher, Calley, Jha); Department of Medicine, MCW, Milwaukee, Wis (Jha).
Corresponding Author: Pinky Jha, MD, MPH, Associate Professor, Department of General Internal Medicine, Medical College of Wisconsin, 8701 W Watertown Plank RD, Milwaukee, WI 53226; phone 414.805.0841; email; ORCID ID 0000-0002-7893-188X
Funding/Support: None declared.
Financial Disclosures: None declared.
Acknowledgement: A signed statement of informed consent to publish was obtained from the patient.
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