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.
|
Parameter |
Patient Value |
Normal Adult Range |
|
Haemoglobin |
65 G/L* |
115 – 165 |
|
White cell count |
2.77 x 109/L* |
3.5 – 11.0 |
|
Platelets |
14 x 109/L |
150 – 400 |
|
Prothrombin Time |
28.9 seconds* |
12.0 – 15.0 |
|
International Normalised Ratio |
2.7* |
0.8 – 1.1 |
|
Activated Partial Thromboplastin Time |
122.5 seconds* |
25.0 – 37.0 |
|
Fibrinogen |
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.
a)
Haemodilution with inadequate replacement of blood and clotting factors
DIC.
b)
a) 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.
b)
A structured approach would resemble the following:
A 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.