The use of fresh frozen plasma or a concentrate of factor IX as replacement therapy before liver biopsy

Thirty patients with various types of chronic liver disease and a prothrombin time prolonged for four or more seconds who required needle liver biopsy for diagnostic purposes were given either fresh frozen plasma or a concentrate of clotting factors as a prophylactic measure. The prothrombin time returned to within normal limits in seven of the 15 patients given the concentrate and in three of those receiving fresh frozen plasma. Levels of factors II, IX, and X showed increases of about 30% following concentrate administration; corresponding rises in the group given fresh frozen plasma were less. This was because of the smaller quantity of clotting factors administered with fresh frozen plasma and the increase in factor II and IX activity/kg body weight/unit of clotting factor injected was greater when fresh frozen plasma was used. In neither group was there clinical evidence of bleeding, but it was of interest that most of the clotting factor levels, except in factor II, before biopsy were above those normally required for haemostasis. No evidence of disseminated intravascular coagulation was found with the concentrate injection, and the most worrying finding was the appearance of HBAg some months later in three patients, two from the concentrate group and one from those given fresh frozen plasma. However, the conversion of these patients to HBAg positive may be unrelated to the clotting factor replacement therapy.