Question 13.1

Created on Tue, 05/12/2015 - 04:51
Last updated on Sat, 10/24/2015 - 22:43
Pass rate: ?
Highest mark: ?

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A 57-year-old female has the following haematological and coagulation profile post admission to the ICU after a laparotomy for intra-abdominal sepsis with significant blood loss.


Patient Value

Normal Adult Range


65 G/L*

115 – 165

White cell count

2.77 x 109/L*

3.5 – 11.0


14 x 109/L

150 – 400

Prothrombin Time

28.9 seconds*

12.0 – 15.0

International Normalised Ratio


0.8 – 1.1

Activated Partial Thromboplastin Time

122.5 seconds*

25.0 – 37.0


1.1 G/L*

2.2 – 4.3

a) List two likely causes of the coagulation abnormalities.

b) State how you would correct the coagulopathy and give your reasoning.

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College Answer


Haemodilution with inadequate replacement of blood and clotting factors



  • Ensure patient is normothermic amd correct acidosis
  • 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.
  • Consider tranexamic acid and/or Activated Factor 7
  • Exclude on-going surgical haemorrhage


a) In contrast to other questions of this nature, this one asks for ONE cause of the coagulopathy. One does not need to degrade oneself with discussions of direct thrombin inhibitor toxicity and post-thrombolysis complications. The answer is obviously a massive transfusion associated with dilutional coagulopathy, with inadequate blood product replacement, and possibly also DIC.


A structured approach would resemble the following:

  • Establish that haemostasis has been achieved, and return to theatre if necessary
  • Control acidosis
  • Restore normothermia
  • Replace clotting factors and platelets:
    • FFP (APTT is high)
    • Cryoprecipitate (fibrinogen is low)
    • Platelets (they are low)
    • Factor VII can be considered
  • Replace RBCs (2 more uints of PRCBc)
  • Consider trahexamic acid

brief discussion of the clotting cascade and of the various factor replacement blood products is available elsewhere.


DeMuro, J. P., and A. F. Hanna. "Trauma Induced Coagulopathy: Prevention and Intervention."Scand J Trauma Resusc Emerg Med 20.47 (2014): 4.