Case report:
A 55-year-old male patient with a history of more than 30 years of
alcohol consumption, averaging about 100-150ml per day, was presented.
Six years ago, he was diagnosed with alcoholic liver disease due to
liver dysfunction and received symptomatic treatment including
abstinence and liver protection at our hospital. Subsequently, he has
been regularly followed up at the Digestive and Liver Disease
Department. Three years ago, he was admitted to our hospital due to
hematemesis. Gastroscopy revealed ruptured and bleeding esophageal
varices. After undergoing EVL for hemostasis and receiving comprehensive
internal medicine treatment, he showed improvement and was discharged.
Post-discharge, he was prescribed oral propranolol (10mg twice a day) to
reduce portal vein pressure. On January 26, 2023, the patient
experienced recurrent hematemesis after consuming solid food, leading to
his emergency admission to our hospital. Routine and biochemical
examinations revealed the following: WBC: 4.67X10^9/L, RBC:
3.28X10^12/L, HGB: 88g/L, PLT: 26X10^9/L, AST: 104U/L, ALT: 31U/L,
DBIL: 24.2umol/L, TBIL: 43.1umol/L, PT: 16.6sec, ALB: 25.1g/L, APTT:
34.5sec, PTA: 46.6%, INR: 1.46, and FIB: 1.020g/L. Computerized
tomography revealed liver cirrhosis, splenomegaly, a small amount of
ascites in the abdominal cavity, and esophageal varices. Emergency
gastroscopy confirmed the presence of ruptured and bleeding esophageal
varices, leading to the clinical diagnosis of alcoholic liver cirrhosis
with decompensated esophageal variceal rupture (Child-Pugh B). With
consent obtained from the patient and his family members, emergency
endoscopic esophageal variceal ligation was performed (refer to Figure I
for the specific procedure). Post-surgery, the patient underwent
fasting, received somatostatin to reduce portal vein pressure, underwent
cefoperazone sodium treatment for anti-infection, received a 400ml
transfusion of suspended red blood cells to correct anemia, and was
provided compound amino acids (3AA) with various vitamins for
symptomatic nutritional treatment following improvement.
On the third day following the surgery (January 30, 2023), the patient
exhibited yellowing of the skin and sclera. The results of blood tests,
liver function, and coagulation function showed deterioration. The
findings were as follows: WBC: 5.73X10^9/L; RBC: 2.79X10^12/L;
HGB: 76g/L; PLT: 36X10^9/L; AST: 222U/L; ALT: 69U/L; DBIL: 219umol/L;
TBIL: 309umol/L; PT: 23.5sec; APTT: 49.9sec; PTA: 29.3%; INR: 2.10;
FIB: 1.52g/L. The clinical diagnosis was acute-on-chronic liver failure
(type B). The patient was advised to observe bed rest and received
magnesium isoglycyrrhizinate injections for liver protection, Transmetil
(Ademetionine 1,4-Butanedisulfonaate) injections to manage jaundice, a
300ml infusion of fresh frozen plasma, and a 400ml intravenous drip of
suspended red blood cells to improve coagulation function and address
anemia. Two days later (February 2, 2023), a re-examination of blood
routine and biochemical indicators revealed the following values: WBC:
6.53x10^9/L; RBC: 3.0x10^12/L; HGB: 81g/L; PLT: 49x10^12/L;
AST: 48U/L; ALT: 131U/L; DBL: 278.4umol/L; TBL:435u/L; PT: 21sec; APTT:
50.4sec; PTA: 34%; FIB: 2.11g/L. However, bilirubin levels continued to
rise, and the patient showed poor response to the comprehensive internal
medicine treatment. With the patient’s and family’s consent, DPMAS+PE
treatment was administered on February 3, 2022. One day later (February
4, 2023), a blood re-examination showed the following results: WBC:
6.17x10^9/L; RBC: 2.63x10^12/L;HGB:72g/L; PLT:48x10^12/L;
AST:79U/L; ALT: 37U/L; DBL:196.3umol/L; TBL :316.0u/L; PT:17.4sec;
APTT:41.6sec; PTA:43.7%; FIB:2.040g/L. DPMAS+PE treatment was
administered once again on February 6th, 2023. The subsequent blood
routine and biochemical indicators, reviewed on February 7th, 2023,
showed the following values: WBC: 5.53x10^9/L; RBC: 2.91x10^12/L;
HGB: 77g/L; PLT: 53x10^12/L; AST: 88U/L; ALT: 43U/L; DBL:
183.9umol/L; TBL: 279.3u/L; PT: 18.7sec; APTT: 40.6sec; PTA: 39.7%;
FIB: 1.870g/L. The patient’s symptoms of poor appetite and fatigue had
significantly improved. On February 9th, 2023, a blood test showed the
following results: WBC: 5.99x10^9/L, RBC: 2.93x10^12/L, HGB:
77g/L, PLT: 55x10^12/L, AST: 99U/L, ALT: 58U/L, DBL: 193.5umol/L,
TBL: 284.2u/L, PT: 19.3sec, APTT: 42.2sec, PTA: 38.1%, FIB: 1.620g/L.
The patient continued to receive basic treatment such as liver
protection and jaundice relief. Additionally, due to the presence of
anemia, another transfusion of suspended red blood cells (400ml) was
administered to address the anemia. On February 12th, 2023, a blood test
showed the following results: WBC: 8.36x10^9/L, RBC: 3.23x10^12/L,
HGB: 83g/L, PLT: 47x10^12/L, AST: 95U/L, ALT: 81U/L, DBL:
185.2umol/L, TBL: 267.6u/L, PT: 20.1sec, APTT: 45.1sec, PTA: 36.1%,
FIB:1.270g/L. Considering the patient’s persisting symptoms of fatigue
and poor appetite, as well as the prolonged elevation of bilirubin
levels, DPMAS+PE treatment was administered again on February 13th,
2023. Two days later (February 15th), a review of blood routine and
biochemical indicators revealed the following values: WBC:
9.05x10^9/L; RBC: 3.22x10^12/L; HGB: 82g/L; PLT: 46x10^12/L;
AST: 58U/L; ALT: 55U/L; DBL: 142.3umol/L; TBL: 197.5u/L; PT: 17.2sec;
APTT: 38.4sec; PTA: 44.4%; FIB: 1.680g/L. Two days later (February
17th), the blood routine and biochemical indicators were reviewed again,
showing the following values: WBC: 5.66x10^9/L; RBC: 3.14x10^12/L;
HGB: 80g/L; PLT: 34x10^12/L; AST: 58U/L; ALT: 66U/L; DBL:
112.8umol/L; TBL: 148.1u/L; PT: 18.4sec; APTT: 42.7sec; PTA: 40.6%;
FIB: 1.210g /L. The patient’s condition remained relatively stable, and
maintenance treatment, including liver protection and jaundice relief,
was continued during this period. Another transfusion of suspended red
blood cells (400ml) was administered to address the anemia.
Two days later, on February 20th, a follow-up blood routine and
biochemical analysis was conducted, revealing the following results:
WBC: 5.95x10^9/L; RBC: 3.87x10^12/L; HGB: 96g/L; PLT:
34x10^12/L; AST: 88U/L; ALT: 96U/L; DBL: 114.6umol/L; TBL: 159.2u/L;
PT: 17.1sec; APTT: 36.7sec; PTA: 44.7%; FIB: 1.640g/L. With the
patient’s condition being stable, the patient and their family requested
discharge due to the high medical expenses. They were informed that the
patient should have a follow-up outpatient visit at the hospital where
the author is located after discharge. Subsequent telephone follow-ups
conducted after March indicated that the patient’s general condition was
good, and they were able to engage in light physical activity.