Acute fatty liver of pregnancy may be associated with non-productive coagulopathy of coagulation and fibrinolytic factors as well as disseminated intravascular coagulation with mild or no thrombocytopenia: Review of case reports in Japan

Abstract

Aim: We reviewed case reports of acute fatty liver of pregnancy (AFLP) in Japan and summarized its characteristics, including coagulation factors, fibrinolytic factors, and platelet counts.

Methods: PubMed/Medline and Ichushi databases from 2000 to 2022 were used to survey articles related to AFLP, and 93 articles (102 patients) were ultimately identified.

Results: The characteristics of the coagulation and fibrinolysis systems in AFLP were as follows: the prothrombin time-international normalized ratio and activated partial prothrombin time were prolonged (median value [quartiles]: 1.59 [1.31, 2.02] and 47.5 s [28.2, 97.5], respectively), and antithrombin and alpha 2-antiplasmin levels were low (23.0% [17.0, 33.0] and 44.6%, respectively), indicating non-productive coagulopathy due to severe liver damage. The concentrations of the thrombin-antithrombin complex and fibrinogen/fibrin degradation products were high (60.0 ng/mL [49.1, 82.8] and 49.2 μg/mL [20.8, 143.7], respectively), while the level of fibrinogen was low (82.0 mg/dL [52.5, 153.5]), suggesting disseminated intravascular coagulation with increased coagulation activity. A platelet count ≥12 × 10⁴/μL was detected in approximately 70% of AFLP cases, and the median was within the normal range (16.1 × 10⁴/μL [11.1, 19.2]).

Conclusions: Coagulopathy changes in AFLP may be based on non-productive coagulopathy of coagulation and fibrinolytic factors as well as disseminated intravascular coagulation with mild or no thrombocytopenia.

Keywords: acute fatty liver of pregnancy; acute liver failure; coagulopathy; disseminated intravascular coagulation; fatty acid.