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21. A 23-year-old female was in her 25th week of preg-
nancy when she ceased to feel fetal movement. Three
weeks later, she has still not delivered, but she suddenly
develops dyspnea with cyanosis and is found to be hypo-
tensive. She has large ecchymoses over her skin and me-
lena. She is found to have an elevated PT and PTT. The
platelet count is decreased. Her plasma fibrinogen is mark-
edly decreased, and fibrin split products are detected. The
most likely cause of her bleeding diathesis is

O (A) Increased vascular fragility
O (B) Toxic injury to the endothelium
O (C) Reduced production of platelets
O (D) Increased consumption of clotting factors and plate-
O (E) Defects in platelet adhesion and aggregation




nod D


21. (D) The presence of thrombocytopenia, increased PT
and PTT values, fibrin split products, and the low fibrino-
gen concentration suggest DIC, which was most likely
caused by a retained dead fetus, an obstetric complication
that can lead to DIC through release of thromboplastins
from the fetus. This causes widespread microvascular
thrombosis and consumes clotting factors and platelets.
There is no damage to the vascular endothelium or vascu-
lar wall. Platelet production is normal, but platelets are
consumed by widespread thrombosis of small vessels.
There is no defect in platelet function.

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