Ho se sebetse ha coagulation ke karolo ea lefu la sebete le ntlha ea bohlokoa ho lintlha tse ngata tse boletsoeng esale pele.Liphetoho tse leka-lekaneng tsa hemostasis li lebisa ho tsoa mali, 'me mathata a ho tsoa mali esale e le bothata bo boholo ba bongaka.Lisosa tsa ho tsoa mali li ka aroloa hoo e ka bang (1) portal hypertension, e sa amane le mochine oa hemostatic;(2) mucosal kapa ho phunya leqeba ho tsoa mali, hangata ka ho qhibiliha pele ho nako ea thrombus kapa fibrinolysis e phahameng, e bitsoang accelerated intravascular coagulation le fibrinolysis ka lefu la sebete Melt (AICF).Mokhoa oa hyperfibrinolysis ha o hlake, empa o kenyelletsa liphetoho ho intravascular coagulation le fibrinolysis.Ho kopana ho sa tloaelehang ho bonahala ho portal vein thrombosis (PVT) le mesenteric vein thrombosis, hammoho le deep vein thrombosis (DVT).Maemo ana a kliniki hangata a hloka kalafo ea anticoagulation kapa thibelo.Microthrombosis sebeteng e bakoang ke hypercoagulability hangata e baka ho fokola ha sebete.
Liphetoho tse ling tsa bohlokoa tseleng ea hemostasis li 'nile tsa hlakisoa, tse ling li atisa ho tsoa mali' me tse ling li atisa ho koala (Setšoantšo sa 1).Ka sebete se tsitsitseng sa sebete, tsamaiso e tla tsosolosoa ka lebaka la lintho tse sa tsitsang, empa tekanyo ena ha e tsitsa 'me e tla ameha haholo ke lintlha tse ling, tse kang boemo ba boemo ba mali, tšoaetso ea tsamaiso le mosebetsi oa liphio.Thrombocytopenia e ka 'na ea e-ba phetoho e tloaelehileng ka ho fetisisa ea mafu ka lebaka la hypersplenism le ho fokotseha ha thrombopoietin (TPO).Ho se sebetse ha platelet le hona ho hlalositsoe, empa liphetoho tsena tsa anticoagulant li ile tsa fokotsoa haholo ke keketseho ea endothelial-derived von Willebrand factor (vWF).Ka mokhoa o ts'oanang, ho fokotseha ha lintlha tsa "procoagulant" tse tsoang sebeteng, joalo ka lintlha tsa V, VII, le X, ho lebisa ho nako e telele ea prothrombin, empa sena se fokotsoa haholo ke ho fokotseha ha lintlha tsa anticoagulant tse tsoang sebeteng (haholo-holo protheine ea C).Ho phaella moo, ntlha e phahameng ea endothelial-derived factor VIII le protheine e tlaase ea C e lebisa boemong bo batlang bo le hypercoagulable.Liphetoho tsena, hammoho le tšenyo e amanang le venous stasis le endothelial triad (Virchow's triad), li lebisitse ho tsoelo-pele ea synergistic ea PVT le DVT ka linako tse ling ho bakuli ba nang le sebete sa sebete.Ka bokhutšoanyane, litsela tsa hemostatic tsa ho thatafala ha sebete hangata li leka-lekana ka mokhoa o sa tsitsang, 'me tsoelo-pele ea lefu lena e ka sekama ka tsela leha e le efe.
Reference:O'Leary JG, Greenberg CS, Patton HM, Caldwell SH.AGA Clinical Practice Update: Coagulation inCirrhosis.Gastroenterology.2019,157(1):34-43.e1.doi:10.1053/j.gastro.2019.03.07. .
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