A Study on the Safety of Liver Biopsy Inpatients with Von Willebrand’s Disease


Objectives: Liver biopsy remains the gold standard for diagnosis of chronic liver diseases. Outpatient percutaneous biopsy is generally safe with a mortality rate of 0.17% and hospitalization rate for bleeding of 3%. Von Willebrand disease (vWD) syndrome is the most common inherited hematological disorder with a prevalence of 1% - 3% globally. We sought to study whether vWD increases the risk of bleeding for liver biopsies. Methods: All patients (n = 120) who underwent outpatient percutaneous liver biopsies from 1997 to 2007 were analyzed. Demographics, PT/INR, platelet count, vW antigen and ristocetin induced platelet aggregation were studied. Results: No vWD patients had major bleeding that required transfusion, hospitalization or surgery but 9 (75%) had minor local bleeding and all had ecchymosis, which resolved spontaneously within 24 hours. Conclusions: Patients with vW factor deficiency can undergo percutaneous liver biopsy without major bleeding. Minor bleeding may occur at a slightly higher rate. vWD is not a contraindication to percutaneous liver biopsy.

Share and Cite:

Basu, P. , Shah, N. , Aloysius, M. , Rayapudi, K. and Brown, R. (2015) A Study on the Safety of Liver Biopsy Inpatients with Von Willebrand’s Disease. Open Journal of Gastroenterology, 5, 134-138. doi: 10.4236/ojgas.2015.59022.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Nguyen, D. and Talwalkar, J.A. (2011) Noninvasive Assessment of Liver Fibrosis. Hepatology, 53, 2107-2110.
[2] Shin, J.L., Teitel, J., Swain, M.G., Bain, V.G., Adams, P.C., Croitoru, K., Peltekian, K., Schweiger, F., Simons, M.E., and Heathcote, E.J. (2005) Virology, Immunology Committee of the Association of Hemophilia Clinic Directors of C. A Canadian Multicenter Retrospective Study Evaluating Transjugular Liver Biopsy in Patients with Congenital Bleeding Disorders and Hepatitis C: Is It Safe and Useful? American Journal of Hematology, 78, 85-93.
[3] Kim, K.R., Ko, G.Y., Sung, K.B., Yoon, H.K., Shin, J.H., Song, H.Y., Ryu, J.H., Hwang, S., Lee, S.G. and Yu, E. (2008) Transjugular Liver Biopsy in Patients with Living Donor Liver Transplantation: Comparison with Percutaneous Biopsy. Liver Transplantation, 14, 971-979.
[4] DiMichele, D.M., Mirani, G., Wilfredo Canchis, P., Trost, D.W. and Talal, A.H. (2003) Transjugular Liver Biopsy Is Safe and Diagnostic for Patients with Congenital Bleeding Disorders and Hepatitis C Infection. Haemophilia, 9, 613-618.
[5] Sadler, J.E., Mannucci, P.M., Berntorp, E., Bochkov, N., Boulyjenkov, V., Ginsburg, D., Meyer, D., Peake, I., Rodeghiero, F. and Srivastava, A. (2000) Impact, Diagnosis and Treatment of von Willebrand Disease. Thrombosis and Haemostasis, 84, 160-174.
[6] Gilmore, I.T., Burroughs, A., Murray-Lyon, I.M., Williams, R., Jenkins, D. and Hopkins, A. (1995) Indications, Methods, and Outcomes of Percutaneous Liver Biopsy in England and Wales: An Audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut, 36, 437-441.
[7] Janes, C.H. and Lindor, K.D. (1993) Outcome of Patients Hospitalized for Complications after Outpatient Liver Biopsy. Annals of Internal Medicine, 118, 96-98.
[8] Brown, K.E., Janney, C.G. and Brunt, E.M. (2000) Liver Disease: Diagnosis and Management. Churchill Livingstone, New York, 47-75.
[9] Caturelli, E., Giacobbe, A., Fac-ciorusso, D., Bisceglia, M., Villani, M.R., Siena, D.A., Fusilli, S., Squillante, M.M. and Andriulli, A. (1996) Percutaneous Biopsy in Diffuse Liver Disease: Increasing Diagnostic Yield and Decreasing Complication Rate by Routine Ultrasound As-sessment of Puncture Site. American Journal of Gastroenterology, 91, 1318-1321.
[10] Rustagi, T., Newton, E. and Kar, P. (2010) Percutaneous Liver Biopsy. Tropical Gastroenterology, 31, 199-212.
[11] Reddy, K. and Schiff, E. (1996) Compli-cations of Liver Biopsy. 2nd Edition, Williams & Wilkins, Baltimore.
[12] Piccinino, F., Sagnelli, E., Pasquale, G. and Giusti, G. (1986) Complications Following Percutaneous Liver Biopsy. A Multicentre Retrospective Study on 68,276 Biopsies. Journal of Hepatology, 2, 165-173.
[13] Pasha, T., Gabriel, S., Therneau, T., Dickson, E.R. and Lindor, K.D. (1998) Cost-Effectiveness of Ultrasound-Guided Liver Biopsy. Hepatology, 27, 1220-1226.
[14] Seltzer, R.A., Rossiter, S.B., Cooperman, L.R. and Liebowitz, D. (1976) Hemobilia Following Needle Biopsy of the Liver. American Journal of Roentgenology, 127, 1035-1036.
[15] Raines, D.R., Van Heertum, R.L. and Johnson, L.F. (1974) Intrahepatic Hematoma: A Complication of Percutaneous Liver Biopsy. Gastroenterology, 67, 284-289.
[16] Lichtenstein, D.R., Kim, D. and Chopra, S. (1992) Delayed Massive Hemobilia Following Percutaneous Liver Biopsy: Treatment by Embolotherapy. American Journal of Gastroenterology, 87, 1833-1838.
[17] Strassburg, C.P. and Manns, M.P. (2006) Approaches to Liver Biopsy Techniques—Revisited. Seminars in Liver Disease, 26, 318-327.
[18] Froehlich, F., Lamy, O., Fried, M. and Gonvers, J.J. (1993) Practice and Complications of Liver Biopsy. Results of a Nationwide Survey in Switzerland. Digestive Diseases and Sciences, 38, 1480-1484.
[19] McGill, D.B., Rakela, J., Zinsmeister, A.R. and Ott, B.J. (1990) A 21-Year Experience with Major Hemorrhage after Percutaneous Liver Biopsy. Gastroenterology, 99, 1396-1400.
[20] Terjung, B., Lemnitzer, I., Dumoulin, F.L., Effenberger, W., Brackmann, H.H., Sauerbruch, T. and Spengler, U. (2003) Bleeding Complications after Percutaneous Liver Biopsy. An Analysis of Risk Factors. Digestion, 67, 138-145.
[21] McMahon, C., Pilkington, R., Shea, E.O., Kelleher, D. and Smith, O.P. (2000) Liver Biopsy in Irish Hepatitis C-Infected Patients with Inherited Bleeding Disorders. British Journal of Haematology, 109, 354-359.
[22] Rockey, D.C., Caldwell, S.H., Goodman, Z.D., Nelson, R.C. and Smith, A.D. (2009) American Association for the Study of Liver D. Liver Biopsy. Hepatology, 49, 1017-1044.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.