Clinical case of hyperfibrinolysis in a patient with biliary atresia

Abstract

Aim - to highlight the issues of diagnosis and treatment of hyperfibrinolysis in the postoperative period in a patient with biliary atresia.

Clinical case. Patient D., diagnosed with a congenital liver malformation, biliary atresia type 3 according to Kasai, underwent laparotomy with intraoperative cholangiography and portoenterostomy on a Roux loop (Kasai procedure). On the 6^th postoperative day, the patient presented with hemorrhagic impurities in the stools. Laboratory tests revealed a decrease in hemoglobin to 65 g/l. Endoscopy did not reveal the source of bleeding. Rotational thromboelastometry (ROTEM) detected hyperfibrinolysis. The patient was prescribed tranexamic acid in a loading dose of 10 mg/kg and a maintenance dose of 2.5 mg/kg/h. The results of a follow-up ROTEM revealed the effectiveness of tranexamic acid which was manifested by a decrease in maximum lysis in the EXTEM pathway. By the eighth day after the surgery, the patient's general condition had stabilized and he was transferred to the emergency surgery department.

Conclusions. Considering the features of the coagulation and fibrinolytic systems, in pediatric patients with liver failure, it is necessary to correct the hemostasis system disorders based on the results not only of standard (international normalized ratio, prothrombin time, activated partial thromboplastin time, fibrinogen) and specific (D-dimer, antithrombin III) coagulation parameters, but with using viscoelastic methods (ROTEM). The integration of the latter allows for timely intervention in the treatment strategy and improves its outcomes.

The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the child's parents to participate in the study.

The authors declare no conflict of interest.