A 57 year old female has the following haematology and coagulation profile post admission  to the intensive care unit after a laparotomy for intraabdominal sepsis with significant  blood loss.

WCC *2.77 (3.5 – 11.00 x109/L)

Hb

*65

(115 –165 g/L)

Platelets

*14

(150-400 x109/L)

PT

*28.9

(12.0 – 15 Sec)

INR

*2.7

(0.8 – 1.1)

APTT

*122.5

(25.0 – 37.0 Sec)

Fibrinogen

*1.1

(2.20-4.30g/L)

 

a) What is the most likely cause of the coagulation abnormalities?


b) How would you correct the coagulopathy and briefly provide a reason for your choice of therapy or therapies?

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College Answer

a) What is the most likely cause of the coagulation abnormalities?

Haemodilution with inadequate replacement of blood and clotting factors DIC

b) How would you correct the coagulopathy and briefly provide a reason for your choice of therapy or therapies?

Ensure patient is normothermic Exclude ongoing surgical haemorrhage Platelets to increase platelet count
FFP to replace factors II, V, VII, IX, X, and XI.
Cryoprecipitate to replace factor VIII, and fibrinogen if FFP does not reverse INR. Activated Factor 7

Discussion

This question is virtually identical to Question 13.1 from the second paper of 2013.