Summary of how routine diagnostic hemostasis tests should be interpreted in liver disease patients
| Laboratory test . | Sensitive for . | Does not assess . | Utility in liver disease . |
|---|---|---|---|
| PT/INR | Factors VII, X, V; prothrombin, and fibrinogen | Other procoagulant factors and anticoagulant proteins | Reflects synthetic capacity of the liver but has no relation to hemostatic status or bleeding |
| APTT | Prekallikrein; high-molecular weight kininogen; factors XII, XI, IX, VIII, X, and V; prothrombin; and fibrinogen | Factor VII and anticoagulant proteins | Has no relation to hemostatic status or bleeding |
| Fibrinogen | Fibrinogen level and function | Polymerisation defects due to increased sialic acid content, altered physical properties of the fibrin clot | Relation between low fibrinogen and bleeding in liver disease unclear |
| Platelet count | Platelet number | Compensation of thrombocytopenia by high VWF levels | Reflects severity of portal hypertension; relation between low platelet count and bleeding risk debated |
| Laboratory test . | Sensitive for . | Does not assess . | Utility in liver disease . |
|---|---|---|---|
| PT/INR | Factors VII, X, V; prothrombin, and fibrinogen | Other procoagulant factors and anticoagulant proteins | Reflects synthetic capacity of the liver but has no relation to hemostatic status or bleeding |
| APTT | Prekallikrein; high-molecular weight kininogen; factors XII, XI, IX, VIII, X, and V; prothrombin; and fibrinogen | Factor VII and anticoagulant proteins | Has no relation to hemostatic status or bleeding |
| Fibrinogen | Fibrinogen level and function | Polymerisation defects due to increased sialic acid content, altered physical properties of the fibrin clot | Relation between low fibrinogen and bleeding in liver disease unclear |
| Platelet count | Platelet number | Compensation of thrombocytopenia by high VWF levels | Reflects severity of portal hypertension; relation between low platelet count and bleeding risk debated |
APTT, activated partial thromboplastin time; INR, international normalized ratio; PT, prothrombin time; VWF, von Willebrand factor.