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Serious hemorrhage complicating diagnostic abdominal paracentesis
1Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
Journal of Clinical Gastroenterology
|July 2, 1998
Summary
Diagnostic paracentesis for spontaneous bacterial peritonitis can cause severe bleeding in liver transplant candidates. Caution is advised for patients with prolonged clotting times, especially those awaiting orthoptic liver transplantation.
Area of Science:
- Hepatology
- Gastroenterology
- Transplantation Medicine
Background:
- Liver transplantation is a critical treatment for end-stage liver disease.
- Spontaneous bacterial peritonitis (SBP) is a common complication in patients with ascites.
- Diagnostic paracentesis is a standard procedure for diagnosing SBP.
Observation:
- Two patients awaiting orthoptic liver transplantation developed major hemorrhage following diagnostic paracentesis for SBP.
- These patients had significantly prolonged prothrombin time (PT) and partial thromboplastin time (PTT) values, exceeding twice the control values.
Findings:
- Diagnostic paracentesis in patients with advanced liver disease and coagulopathy carries a high risk of hemorrhage.
- The risk is particularly elevated when PT or PTT is more than double the normal range.
Implications:
- Clinicians should exercise extreme caution when performing paracentesis in liver transplant candidates with impaired coagulation.
- Pre-procedure coagulation assessment and potential correction are crucial to mitigate bleeding risks.
- This finding highlights the need for careful patient selection and procedural planning in liver transplant recipients.