VII. TEACHING POINTS

1. The liver is responsible for synthesis of all of the clotting factors.
2. Patients with liver disease frequently have elevations of the protime (PT) but can also have elevations of the partial thromboplastin time (aPTT)
3. The PT is usually affected first, as factor VII has the shortest half-life of the clotting factors.
4. Thrombocytopenia is common in liver disease as a result of splenic sequestration. Hepatitis C can lead to marrow underproduction of platelets, further reducing the platelet count.
5. Fresh frozen plasma (FFP) is a source of clotting factors.
6. Spur cell hemolytic anemia can result from severe liver disease.

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