DISSIMINATED INTRAVASCULAR COAGULATION IN CHRONIC LIVER DISEASE AND ITS IMPACT ON ACUTE VARICEAL BLLEDING

The liver plays a central role in the maintenance of haemostasis as the site of protein synthesis required for regulation of coagulation and fibrinolysis. So, impairment of liver parenchymal cell function can disturb haemostasis resulting in the development of multiple coagulation abnormalities. Disseminated intravascular coagulation (DIC) is characterized by activation of the clotting cascade by a magnitude overpowering the anticoagulation pathway, resulting in widespread intravascular fibrin deposition and ultimately, arterial or venous thrombosis and multiorgan failure Disseminated intravascular coagulation in patients with liver disease involves multiple triggering mechanisms. Patients & Methods: 60 patients with chronic liver disease were classified into two main groups : group I 30 patient non bleeder and group II 30 patient presented by haemetemesis and / or melena precipitated by endoscopically evident oesophageal variceal rupture each group subdivided according to Child’s–Pugh classification into A,B &C. laboratory investigation and clinical evaluation were done then calculation of DIC score according to international society of thrombosis and haemostasis ( ISTH) Diagnostic Scoring System for DIC. Results: Combined HCV&HBV represent 52.4%among child class C. As regard to DM no significant differences but there was significant association between hypertension and child class A, 50%of patients in child class A were hypertensive. Significant association between portal vein thrombosis in bleeder group and increasing child class, 7 patients had PVT were child class C. By ANOVA significant association between increasing child class and decrease platelet count, increase fibrinogen, prolongation of PT, and DIC Conclusion: DIC correlated with advanced cirrhosis with increasing Child’s–Pugh score from A to C.