Coagulopathy and transfusion therapy in pediatric liver transplantation

Table 3 Factors implicated in rebalancing

System	Increases	Decreases
Clotting cascade	Factor VIII	Procoagulation factors V, VII, IX, X, XI, prothrombin
		Vitamin K-dependent procoagulation factors II, VII, IX , X
		Vitamin K-dependent anticoagulation factors protein C and protein S; anticoagulant proteins synthesized by the liver such as protein Z, protein Z-dependent protease inhibitor, antithrombin, heparin cofactor II, and alpha-2-macroglobulin
		Fibrinogen and dysfibrinogenemia
Clot lysis	Tissue plasminogen activator (tPA) (due to enhanced release by the activated endothelium and/or by reduced hepatic clearance)	Plasminogen, antiplasmin (alpha-2 plasmin inhibitor or alpha-2 PI), thrombin-activatable fibrinolysis inhibitor (TAFI), and factor XIII
	Levels of plasminogen activator inhibitor (PAI-1)
Platelet	Plasma von Willebrand factor (vWF; main platelet vessel wall adhesive protein)	Thrombocytopenia and thrombocytopathy (usually from hypersplenism, altered levels of thrombopoietin metabolism, antiplatelet antibodies and defective platelet aggregation)
		ADAMTS-13 (vWF cleaving protease)