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Euglobulin lysis time is a modified plasma clot lysis time and measures increased plasminogen activation. The euglobulin lysis time was 60 seconds (normal, >180 seconds). Alpha-2 antiplasmin was low at 20% (normal range, 80–120%). The serum fibrinogen level was low, at 104 mg/dL (normal range, 175–400 mg/dL), and antithrombin III was low at 24% (normal range, 80–120%). All liver-dependent coagulation factors were low (Table 1). Laboratory testing showed that hemoglobin was 6.5 g/dL, platelet count was 110,000/mm 3, prothrombin time was 16.3 seconds, international normalized ratio was 1.6, and partial thromboplastin time was 40 seconds. His Child-Pugh classification was category B, with a score of 8. There was a large, tender hematoma involving the neck and the back with extension into the flanks. The physical examination showed severe pallor, conjunctival icterus, and splenomegaly. He had not experienced any physical trauma and was not receiving antiplatelet agents or anticoagulants. We present a case of a cirrhotic patient with extensive spontaneous ecchymosis and an acute drop in hemoglobin level, which were due to primary hyperfibrinolysis.Ī 65-year-old man with alcoholic cirrhosis presented with extensive bruises on his back. 1 Hyperfibrinolysis in cirrhotic patients is the result of excess fibrin breakdown leading to defective hemostasis. Nair, MD, Department of Pulmonary and Critical Care, Winthrop University Hospital, 222 Station Plaza, Suite 400, Mineola, NY 11501 Phone: 51 Fax: 51 E-mail: coagulopathy in advanced hepatic disease is characterized by coagulation factor deficiencies as well as accelerated fibrinolysis. 1Department of Internal Medicine 2Division of Gastroenterology 3Division of Hematology-Oncology, William Beaumont Hospital, Royal Oak, MichiganĪddress correspondence to: Girish B.

Bruise positive bruise normal negative tb test pictures