Bleeding Complication With Liver Biopsy: Is It Predictable? Stephen Caldwell, MD, Patrick G. Northup, MD  Clinical Gastroenterology and Hepatology  Volume 8, Issue 10, Pages 826-829 (October 2010) DOI: 10.1016/j.cgh.2010.06.010 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 Variation between different clinical reference laboratories in INR values on identical samples from patients with cirrhosis. High and low values for identical sample sets are shown. The variation is thought to result from differences in thromboplastin reagents. The values straddle the 1.5 cutoff in 8 of 19 cases. Aside from the substantial physiological limitations of this test (based on abnormalities of the hemostatic system in cirrhosis; see text), this degree of interlaboratory variation renders nonsensical the application of a universal clinical cutoff value as a measure of bleeding risk in cirrhosis patients although it remains a valid indicator in warfarin therapy for which the test was developed. Clinical Gastroenterology and Hepatology 2010 8, 826-829DOI: (10.1016/j.cgh.2010.06.010) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 (A) A 48-year-old male with human immunodeficiency virus (HIV) in remission and possible drug-induced liver disease underwent ultrasound-guided biopsy with 16-gauge automated needle with a single pass. Prebiopsy INR = 0.9 and platelets 71,000/mL. Developed pain and decreased blood pressure postbiopsy. Computerized tomography (CT) showed site of bleeding (arrow). (B) Same patient underwent arteriography showing arterial extravasation (arrow). (C) Same patient status post coiling of the bleeding site. (D) Biopsy sample shows vessel wall of very small artery which likely represents the site of bleeding (H&E 200×). (E) Closer view of (D) (H&E 400×). Clinical Gastroenterology and Hepatology 2010 8, 826-829DOI: (10.1016/j.cgh.2010.06.010) Copyright © 2010 AGA Institute Terms and Conditions