Obstructive jaundice and coagulation disturbances

Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):17-21.

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“Proper management includes full replacement of water and electrolyte deficiency, prophylactic antibiotics, lactulose, vitamin K and fresh frozen plasma, albumin and dopamine. The preoperative biliary drainage has not been indicated in overall, but only in a few selected cases.”

“The coagulation disorders and the resulting hemostasis impairment have been attributed to the complement activation by endotoxin as well as to the reduced synthesis of prothrombin (factor II) in the liver and the other vitamin K depended coagulation factors i.e. VII, IX, X and proteins C, S, Z. The absence of bile salts in the gut prevents the absorption of vitamin K, which is a fat-soluble vitamin. In addition, the endogenous microbial flora produces small amounts of vitamin K. Subsequently the reduced vitamin K absorption results in its deficiency. The latter predisposes to bleeding diathesis, despite the normal laboratory indices such as prothrombin time (PTT) and international normalized ratio (INR). Likewise, the other fat-soluble vitamin D and lipids absorption is diminished resulting in their deficiency and calcium reduction.” (Pavlidis, et al., p. 19.)

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Article of interest: COVID-19 associated hyperviscosity: a link between inflammation and thrombophilia?

Maier CL, Truong AD, Auld SC, Polly DM, Tanksley CL, Duncan A. COVID-19 associated hyperviscosity: a link between inflammation and thrombophilia? Lancet. 2020 May 25:S0140-6736(20)31209-5. Epub ahead of print.

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“The 15 patients had plasma viscosity exceeding 95% of normal, as determined by traditional capillary viscometry, ranging from 1·9–4·2 centipoise (cP; normal range 1·4–1·8). Notably, the four patients with plasma viscosity above 3·5 cP had a documented thrombotic complication: one patient had pulmonary embolism, one patient had limb ischaemia and suspected pulmonary embolism, and two patients had CRRT-related clotting. Plasma viscosity and Sequential Organ Failure Assessment scores, a measure of illness severity, were strongly correlated (Pearson’s r=0·841, R2=0·7072, p<0·001; appendix).”

Emory doctors study link between thickness of blood, clotting and inflammation in COVID-19 patients.