A 27-year-old male presents to the ICU febrile, ill and bleeding with the following results:
Parameter |
Patient Value |
Adult Normal Range |
Prothrombin time (PT) |
60.7 sec* |
12.0 – 16.5 |
International normalised ratio (INR) |
4.7* |
0.9 – 1.3 |
Activated partial thromboplastin time (APTT) |
> 220.0 sec* |
27.0 – 38.5 |
Fibrinogen |
0.2 g/L* |
2.0 – 4.0 |
Platelet count |
12 x 109/L* |
150 – 350 |
Prothrombin time mixing study |
13.8 sec |
|
APTT mixing study |
33.5 sec |
a) List three differential diagnoses for this presentation. (20% marks)
"Febrile, ill and bleeding" with a mixing study which corrects all the parameters suggests that all the clotting factors are somehow missing. They could have been missing for some time, or this could be an acute thing. Moreover, the fibrinogen and platelets are also very low.
What could cause this sort of pan-coagulopathy?
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