Liver Function Bleeding Risk — MFDS Part 1 MCQ

Correct answer: B — Prothrombin time (PT), expressed as INR

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

A is correct. PT, commonly standardised as the INR, most directly reflects reduced hepatic synthesis of coagulation factors among the listed tests. ALT and GGT primarily indicate hepatocellular injury or enzyme induction/cholestasis, while bilirubin assesses excretory function. Albumin is also a marker of hepatic synthesis, but its long half-life and lack of direct measurement of coagulation make it less relevant to haemostasis. However, PT/INR must not be treated as a stand-alone predictor of extraction bleeding in cirrhosis. Chronic liver disease can also cause thrombocytopenia and platelet dysfunction, and modern evidence shows that INR correlates poorly with procedural bleeding. Assessment should therefore include platelet count, bleeding history, disease severity, medications and, where appropriate, liaison with the patient's medical specialist.

Reference: NHS Specialist Pharmacy Service. Assessing liver function and interpreting liver blood tests, section ‘PT’. 2024. https://sps.nhs.uk/articles/assessing-liver-function-and-interpreting-liver-blood-tests/