The liver is the site of production for the vast majority of our clotting factors. Therefore, impaired liver function could adversely affect these hemostatic proteins. Indicators of a potential liver problem include:
- A decrease in the vitamin K-dependent factors, starting with factor VII, followed by reductions in factor II and X levels. Factor V levels are decreased in both acute and chronic liver disease, while factor IX levels are typically slightly reduced until advanced stages of liver disease.
- An increase in factor VIII. There is an increased production of factor VIII by the sinusoidal endothelial cells when the liver is damaged.
- The PT is sensitive to liver function, so an unexpected, prolonged PT should be evaluated.
- A lack of fibrinogen is often indicative of severe liver disease.
- It is difficult to treat liver disease, so therapy typically centers around replacing the missing factors by way of administration of fresh frozen plasma.