Ongoing life-threatening liver bleeding (hemoperitoneum) post-liver biopsy in a patient with end stage cirrhosis and advanced liver failure. Bilirubin >400.
INR rapidly increased after the liver biopsy indicating grossly impaired synthetic function. In the 12 hours prior to the attempted embolization of the site of hemorrhage the patient was anuric with a systolic blood pressure having dropped to 60mmHg and requiring ICU support. Large volume transfusions of products were given to to correct the coagulopathy - INR reduced from 6.6 to 1.8. Post 5 unit blood transfusion - Hb had not improved.