esculapio2004
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- A 33-year-old woman gives birth to a baby girl. The next day, she begins to bleed from her vagina and from venipuncture sites. Laboratory studies demonstrate decreased platelets, prolonged prothrombin time (PT) and partial thromboplastin time (PTT), and increased fibrin split products. These features are most consistent with which of the following?
A. Disseminated intravascular coagulation
B. Hemophilia A
C. Severe liver disease
D. Vitamin K deficiency
E. Von Willebrand's disease
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| Addicudo
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A. Disseminated intravascular coagulation
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| SDK
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It is A...fibrin degradating products.....DIC 8)
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| esculapio2004
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The correct answer is A. The patient is experiencing disseminated intravascular coagulation (DIC), a feared,
and often life-threatening complication of many other disorders, including amniotic fluid embolism, infections
(particularly gram-negative sepsis), malignancy, and major trauma. The diagnosis is suspected when both a
decrease in platelets and a prolongation of PT and PTT times are observed. The observed hematologic
abnormalities are due to consumption of platelets and clotting factors, caused by extensive microclot formation
with accompanying fibrinolysis (reflected by the increased fibrin split products). The D-dimer assay measures
cross-linked fibrin derivatives, and is a specific test for fibrin degradation products.
Hemophilia (choice B) will alter the PTT without affecting the other indices.
Severe liver disease (choice C) produces alterations comparable to those in vitamin K deficiency, and platelets
can also be decreased secondary to a generalized metabolic marrow dysfunction, but fibrin split products would
not be increased.
Vitamin K deficiency (choice D) is associated with alterations in both PT and PTT, but platelets will not be
decreased, nor will fibrin split products be increased.
Von Willebrand's disease (choice E) produces impaired platelet adhesion and increases the bleeding time as
well as the PTT, but will not produce the other features described.
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