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Haemorrhage after liver biopsy | Signal

Reference number
1104 D
Issue date24 September 2009

This ‘Signal’ is about the need for careful monitoring after liver biopsy procedure for early signs and symptoms of haemorrhage.


Extract from incident reported to the RLS:
 “The Consultant Radiologist reported the patient came in for ultrasound guided liver biopsy. Her INR was 1.1. Cons Radiologist attempted the biopsy… 2 cores obtained, one by the Reg. The patient developed hypotension and given IV fluid. 2 hours later she developed haematoma. Post biopsy bleed query from primary disease. IV fluid (normal saline) + 500 ml of gelofusine…”


Liver biopsy is an important diagnostic procedure, but carries the risk of internal haemorrhage. Anticoagulant and anti-platelet medication may need to be discontinued, and blood samples taken for ‘group and save’. Close observation in the period following the biopsy is vital.


Following a search of the Reporting and Learning System (RLS), eight patient deaths related to bleeding post-biopsy, and six serious and five minor haemorrhages were identified. Although most appeared to occur despite correct management, problems included failure to communicate clotting problems before the procedure, stop an anti-platelet medication, no ‘group and save’ being available or not acting on deterioration.


The National Reporting and Learning Service (NRLS) is exploring the issue further with clinical experts and the British Society of Gastroenterology, which has produced guidelines on carrying out biopsies. Possible areas for action from the data include the need for careful monitoring and nursing care after biopsy for early warning signs of haemorrhage.


We would like to hear from you – please contact us  with anonymised copies of local investigations or information about your initiatives to reduce risks in any of these areas. 


Signals are notifications of key risks emerging from review of serious incidents reported and shared by the NRLS.


Relevant to: medicine



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