Ukungasebenzi kahle kwe-coagulation kuyingxenye yesifo sesibindi futhi kuyisici esiyinhloko kumaphuzu amaningi okubikezelwa.Izinguquko ebhalansi ye-hemostasis ziholela ekopheni, futhi izinkinga zokopha bezilokhu ziyinkinga enkulu yomtholampilo.Izimbangela zokopha zingahlukaniswa cishe zibe (1) i-portal hypertension, engahlangene ne-hemostatic mechanism;(2) ukopha kwe-mucosal noma ukubhoboza isilonda, ngokuvamile ngokuqedwa ngaphambi kwesikhathi kwe-thrombus noma i-fibrinolysis ephezulu, okubizwa ngokuthi i-accelerated intravascular coagulation kanye ne-fibrinolysis kusifo sesibindi Melt (AICF).Indlela ye-hyperfibrinolysis ayicacile, kodwa ihilela izinguquko ku-intravascular coagulation kanye ne-fibrinolysis.I-coagulation engavamile ibonakala ku-portal vein thrombosis (PVT) kanye ne-mesenteric vein thrombosis, kanye ne-deep vein thrombosis (DVT).Lezi zimo zomtholampilo ngokuvamile zidinga ukwelashwa kwe-anticoagulation noma ukuvimbela.I-Microthrombosis esibindini ebangelwa i-hypercoagulability ngokuvamile ibangela ukuhluleka kwesibindi.
Ezinye izinguquko eziyinhloko endleleni ye-hemostasis ziye zacaciswa, ezinye zivame ukopha kanti ezinye zivame ukujika (Umfanekiso 1).Ku-cirrhosis yesibindi esizinzile, uhlelo luzophinde lulinganiswe ngenxa yezinto ezingasebenzi kahle, kodwa le bhalansi ayizinzile futhi izothinteka kakhulu ezinye izici, njengesimo somthamo wegazi, ukutheleleka kwesistimu, nokusebenza kwezinso.I-Thrombocytopenia ingaba ushintsho oluvame kakhulu lwe-pathological ngenxa ye-hypersplenism kanye nokuncipha kwe-thrombopoietin (TPO).Ukungasebenzi kahle kwe-platelet nakho kuye kwachazwa, kodwa lezi zinguquko ze-anticoagulant zaqedwa ngokuphawulekayo ukwanda kwe-endothelial-derived von Willebrand factor (vWF).Ngokufanayo, ukuncipha kwezici ze-procoagulant ezitholakala esibindini, njengezici V, VII, no-X, kuholela esikhathini eside se-prothrombin, kodwa lokhu kulungiswa ngokuphawulekayo ukwehla kwezici ze-anticoagulant ezitholakala esibindini (ikakhulukazi iphrotheni C).Ngaphezu kwalokho, i-endothelial-derived factor VIII ephakeme kanye ne-protein C ephansi iholela esimweni esilinganiselwe se-hypercoagulable.Lezi zinguquko, zihambisana nokulimala kwe-venous stasis kanye nokulimala kwe-endothelial (i-Virchow's triad), kuholele ekuqhubekeleni phambili kwe-PVT kanye ne-DVT eyenzeka ngezikhathi ezithile ezigulini ezine-cirrhosis yesibindi.Ngamafuphi, izindlela ze-hemostatic ze-cirrhosis yesibindi zivame ukulinganisa ngendlela engazinzile, futhi ukuqhubeka kwesifo kungatshekiswa kunoma iyiphi indlela.
Inkomba: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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