Successful Spinal Anesthesia in a Patient With Severe Coagulopathy From Acute Liver Disease of Pregnancy Undergoing Cesarean Section: A Case Report

We present a case of acute fatty liver of pregnancy (AFLP) with significant coagulopathy despite no bleeding symptoms, which was managed with spinal anesthesia without adverse events. This phenomenon may not be attributable to coincidence alone. Upon reviewing the literature, standard coagulation tests fail to account for the simultaneous reduction in pro- and anticoagulant factors, leading to a misleading impression of coagulopathy and often overestimating the risk of bleeding. Thus, it is advised that coagulopathy tests associated with liver disease should not be used solely to dictate anesthesia decisions; a thorough history obtained from the patient, family, or medical records may be more informative than abnormal coagulation tests.