A 24 year old female has the following haematology and coagulation profile post admission to the intensive care unit following post partum haemorrhage.
|
Test |
Value |
Normal range |
|
WCC |
5.6 |
(4.0-11.0) |
|
Hb |
60* |
(115-165G/L) |
|
Platelets |
30* |
(150-400 X 109/L) |
|
PT |
30.6* |
(10.5-13.5 sec) |
|
APTT |
>150* |
(21-36 sec) |
|
D Dimer |
>10* |
(<0.4 microgram/ml FEU) |
|
Fibrinogen |
0.8* |
(1.1-3.2G/L) |
a) What is the likely cause of these coagulation abnormalities?
b) In this context, list 3 likely causes of this coagulation profile.
c) What does an elevated D-dimer indicate ?
a) What is the likely cause of these coagulation abnormalities?
DIC
b) In this context, list 3 likely causes of this coagulation profile.
c) What does an elevated D-dimer indicate ?
Tests fibrinolysis. It measures the break down of the X linked fibrin
The college asks for one likely cause of this coagulopathy. DIC is the standard answer with this sort of history. More broadly, differentials for thrombocytopenia and pan-coagulopathy could also include massive transfusion and severe liver disease.
There is quite a large number of potential peripartum causes for DIC:
Fibrin degradation products seem to be a valuable adjunct for the laboratory diagnosis of DIC.
In essence, a D-dimer is a small protein breakdown product, consising of two crosslinked D-fragments of fibrin.
A longer explanation, with pictures and extensive bibliography, is also available.
The presence of an elevated D-dimer confrms that somewhere fibrin is being degraded.
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