- Clinical case of hyperfibrinolysis in a patient with biliary atresia
Clinical case of hyperfibrinolysis in a patient with biliary atresia
Ukrainian Journal of Perinatology and Pediatrics. 2026.1(105): 108-112. doi: 10.15574/PP.2026.1(105).108112
Faryna L. I.1,2, Holovatiuk M. V.2, Diehtiarova D. S.2,3, Godik O. S.2,3
1Shupyk National Healthcare University of Ukraine, Kyiv
2National Children’s Specialized Hospital «OKHMATDYT», Kyiv, Ukraine
3Bogomolets National Medical University, Kyiv, Ukraine
For citation: Faryna LI, Holovatiuk MV, Diehtiarova DS, Godik OS. (2026). Clinical case of hyperfibrinolysis in a patient with biliary atresia. Ukrainian Journal of Perinatology and Pediatrics. 1(105): 108-112. doi: 10.15574/PP.2026.1(105).108112.
Article received: Dec 15, 2025. Accepted for publication: Feb 16, 2026.
Aim – to highlight the issues of diagnosis and treatment of hyperfibrinolysis in the postoperative period in a patient with biliary atresia.
Clinical case. Patient D., diagnosed with a congenital liver malformation, biliary atresia type 3 according to Kasai, underwent laparotomy with intraoperative cholangiography and portoenterostomy on a Roux loop (Kasai procedure). On the 6th postoperative day, the patient presented with hemorrhagic impurities in the stools. Laboratory tests revealed a decrease in hemoglobin to 65 g/l. Endoscopy did not reveal the source of bleeding. Rotational thromboelastometry (ROTEM) detected hyperfibrinolysis. The patient was prescribed tranexamic acid in a loading dose of 10 mg/kg and a maintenance dose of 2.5 mg/kg/h. The results of a follow-up ROTEM revealed the effectiveness of tranexamic acid which was manifested by a decrease in maximum lysis in the EXTEM pathway. By the eighth day after the surgery, the patient's general condition had stabilized and he was transferred to the emergency surgery department.
Conclusions. Considering the features of the coagulation and fibrinolytic systems, in pediatric patients with liver failure, it is necessary to correct the hemostasis system disorders based on the results not only of standard (international normalized ratio, prothrombin time, activated partial thromboplastin time, fibrinogen) and specific (D-dimer, antithrombin III) coagulation parameters, but with using viscoelastic methods (ROTEM). The integration of the latter allows for timely intervention in the treatment strategy and improves its outcomes.
The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from the child's parents to participate in the study.
The authors declare no conflict of interest.
Keywords: hyperfibrinolysis, tranexamic acid, biliary atresia, liver failure, bleeding, children, Kasai procedure.
REFERENCES
1. Albisetti M. (2003). The Fibrinolytic System in Children. Semin Thromb Hemost. 29(4): 339-348. https://doi.org/10.1055/s-2003-42585; PMid:14517746
2. Dievoet M, Zouaoui Boudjeltia K, Rousseaux M, Douxfils J, Lisman T, Stephenne X. (2024, Aug 20). Fibrinolytic profile depends on disease severity in pediatric patients with cirrhosis: illustration by 2 different plasma-based fibrinolysis assays. Res. and Pract. in Throm. and Haemos. 8(6) 102551. https://doi.org/10.1016/j.rpth.2024.102551; PMid:39290990 PMCid:PMC11406019
3. Goobie S, Faraoni D. (2019, Jun). Tranexamic acid and perioperative bleeding in children: what do we still need to know? Curr. Opin. Anaesthesiol. 32(3): 343-352. https://doi.org/10.1097/ACO.0000000000000728; PMid:30893114
4. Goobie S, Faraoni D. (2025, Jan). Perioperative paediatric patient blood management: a narrative review. Br J Anaesth. 134: 168-179. https://doi.org/10.1016/j.bja.2024.08.034; PMid:39455307
5. Kietaibl S, Ahmed A, Afshar A, Albaladejo P, Aldecoa C, Barauskas G et al. (2023). Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology second update 2022. Eur J Anaesthesiol. 40: 226-304. https://doi.org/10.1097/EJA.0000000000001803; PMid:36855941 PMCid:PMC10601341
6. Marcucci C, Schoettker P et al. (2015). Perioperative Hemostasis, Springer-Verlag Berlin Heidelberg. 2015: 285-287. https://doi.org/10.1007/978-3-642-55004-1_16
7. Marinho D. (2020, Dec 25). Perioperative hyperfibrinolysis – physiology and pathophysiology. Braz. J Anesthesiol. 71(1): 65-75. https://doi.org/10.1016/j.bjane.2020.12.007; PMid:33712256 PMCid:PMC9373513
8. Schadena E, Saner F, Görlinger K. (2013) Coagulation pattern in critical liver dysfunction. Curr Opin Crit Care. 19(2): 142-148. https://doi.org/10.1097/MCC.0b013e32835ebb52; PMid:23400090