Background: There is a necessity of effective hemostasis with the possible occurrence of delayed bleeding after laparoscopic liver biopsy in conditions of coexisting prothrombotic and hemorrhagic disorders.

Aims: To analyze hemostasis system disorders and opportunities of their correction during laparoscopic liver biopsy in an infant with antenatal cryptogenic hepatitis.

Methods: An infant, 2 months old, was treated in the perinatal center of Saint Petersburg State Pediatric Medical University clinic with antenatal cryptogenic hepatitis complicated by hepatocellular failure. To assess the severity of damage and fibrosis, laparoscopic liver biopsy was made. The hemostatic system was assessed by platelet count, APTT, PT-INR, fibrinogen level, antithrombin (AT), PrC, PrS activity, thromboelastography data.

Results: There were no clinical manifestations of hemorrhagic syndrome before laparoscopic liver biopsy. Platelet level was 125×10.9/l, APTT – 2,31/68,2s(0,80-1,2/25,1-36,5s); PT – 21,1/44%(10,6-13,7s/80-120%); INR – 1,8(1,0); fibrinogen – 0,8 g/l(2-4 g/l). The results of thromboelastography: R min 5,6; K min 3,9; Angle deg 47,7; MA mm 35,9 (hypocoagulation). AT and PrC activity levels were extremely low (AT< 7,2%; PrC - 0%). Thus, the patient had a potential risk of both hemorrhagic and thrombotic complications.

Conclusions: Hepatocellular failure was key factor in the imbalance of coagulation and anticoagulation systems with the threat of both hemorrhagic and thrombotic complications during laparoscopic liver biopsy. In our opinion, the combination of FFP and the recombinant factor VII effectively stopped intraabdominal bleeding and was safe without possible thrombotic complications at critically low levels ​​of AT and PrC.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/application-of-the-first-russian-biosimilar-of-recombinant-clotting-factor-vii-in-an-infant-with-antenatal-cryptogenic-hepatitis-and-bleeding-developed-after-laparosopic-liver-biopsy/