Recombinant activated factor Vila in case of pregnancy with acute hepatic failure and massive blood loss

摘要

The case report 'Recombinant activated factor Vila in case of pregnancy with acute hepatic failure and massive blood loss' published in MJAFI in October 2011 {MJAFI 2011;67:390-393) was interesting and we would like clarification on some points and offer these comments.1. Recombinant activated factor Vila (rFVIIa) is thought to act locally at site of tissue injury and vascular wall disruption by binding to exposed tissue factor, generating small amounts of thrombin that are sufficient to activate platelets.2. The activated platelet surface can then form a template on which rFVIIa directly or indirectly mediates further activation of coagulation ultimately generating much more thrombin and leading to the conversion of fibrinogen to fibrin.3. Therefore adequate platelet count is must before administering rFVIIa. Here platelet count was just 40,000/mm 4. Anasarca in a case of acute hepatic failure cannot be explained. Serum albumin level and renal parameters are not given in this case.5. Acute hepatic failure in ultrasonography should reveal shrunken liver, not a normal liver span.