31 January 2023
: Case report
A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM)
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care
Uzung Yoon1ABCDEF*, Manny Lai1E, Tho Nguyen1EF, Elia Elia1EDOI: 10.12659/AJCR.938500
Am J Case Rep 2023; 24:e938500
Table 1. Conventional coagulation testing values and viscoelastic coagulation testing values during patient’s hospital stay.
Ref. range | Day 1 21: 56 | Day 2 12: 11 | Day 2 18: 25 | Day 3 02: 04 | Day 3 03: 10 | Day 3 07: 18 | Day 3 16: 19 | |
---|---|---|---|---|---|---|---|---|
PT | 8.9–13.1 sec | >100.0 | >100.0 | 56.1 | 32.1 | 34.0 | 24.0 | 40.5 |
INR | 0.81–1.19 | >8.71 | >8.71 | 4.94 | 2.86 | 3.02 | 2.15 | 3.59 |
PTT | 24–35 sec | 30 | 35 | 32 | 28 | 29 | 26 | 35 |
D-Dimer | <204 ng/mL | 10658 | 10515 | 7649 | 5772 | 5979 | 6207 | 21797 |
Fibrinogen | 204–462 mg/dL | 116 | 94 | 120 | 218 | 198 | 231 | 138 |
Notes | ROTEM 2FFP | 2FFP 2CRYO | 3FFP 3CRYO | 2FFP | Central line placed | |||
PT – prothrombin time; PTT – partial thromboplastin time; INR – international normalized ratio; ROTEM – rotational thromboelastometry; CRYO – cryoprecipitate. | ||||||||
Ref. range | Day 4 11: 25 | Day 4 17: 45 | Day 5 00: 16 | Day 5 07: 57 | Day 5 16: 12 | Day 6 00: 08 | Day 6 08: 29 | |
PT | 8.9–13.1 sec | 43.0 | 43.7 | 25.9 | 33.6 | 31.5 | 33.4 | 25.8 |
INR | 0.81–1.19 | 3.80 | 3.86 | 2.31 | 2.99 | 2.80 | 2.97 | 2.31 |
PTT | 24–35 sec | 34 | 35 | 33 | 35 | 35 | 42 | 37 |
D-Dimer | <204 ng/mL | 18442 | 16097 | >69000 | 66681 | 49010 | >69000 | 65573 |
Fibrinogen | 204–462 mg/dL | 108 | 96 | 118 | 69 | 134 | 40 | 118 |
Notes | 2FFP 3CRYO | 2 CRYO | 2 CRYO | |||||
PT – prothrombin time; PTT – partial thromboplastin time; INR – international normalized ratio; ROTEM – rotational thromboelastometry; CRYO – cryoprecipitate. |