A 38-year-old female presents to the Emergency Department with complaints of lower abdominal pain and vaginal bleeding. On examination, she is confused and, with cool peripheral perfusion and patchy ecchymoses over her extremities. Vaginal examination reveals clots, with tissue resembling products of conception. She is tachypneic, tachycardic with a non-invasive blood pressure of 88/42 mmHg.
(Parts 24.1 and 24.2 of the question are related to the initial blood results obtained from this patient.)
Full blood count and coagulation results are shown below:
Parameter | Patient Value | Adult Normal Range | |||||||||||||||
Haemoglobin | 93 g/L* | 120 – 160 | |||||||||||||||
Mean Cell Volume | 85 fL | 80 – 100 | |||||||||||||||
Mean Corpuscular Haemoglobin (MCH) |
28.0 pg | 27.5 – 33.0 | |||||||||||||||
White Cell Count | 24.0 x 109/L* | 4.0 – 11.0 | |||||||||||||||
Platelet count | 25 x 109/L* | 150 – 350 | |||||||||||||||
Parameter | Patient Value | Adult Normal Range | |||||||||||||||
Prothrombin time | 24.0 sec* | 12.0 – 16.5 | |||||||||||||||
INR | 2.2* | 0.9 – 1.3 | |||||||||||||||
APTT | > 200.0 sec* | 27.0 – 38.5 | |||||||||||||||
Fibrinogen | < 0.4 g/L* | 2.0 – 4.0 |
a) Explain the abnormalities for the full blood count and coagulation parameters, and list one likely pathological diagnosis. (20% marks)
b) This patient continues to have ongoing vaginal bleeding along with ooze from invasive lines. Outline your principles of management. (20% marks)
Not available.
Explain the abnormalities:
List one likely pathological diagnosis:
Principles of management of DIC(SIC):
Slofstra, Sjoukje, Arnold Spek, and Hugo ten Cate. "Disseminated intravascular coagulation." The Hematology Journal 4.1 (2013): 295-302.
Levi, Marcel, and Hugo Ten Cate. "Disseminated intravascular coagulation."New England Journal of Medicine 341.8 (1999): 586-592.
Letsky, Elizabeth A. "Disseminated intravascular coagulation." Best Practice & Research Clinical Obstetrics & Gynaecology 15.4 (2001): 623-644.
Carr, J. Meehan, M. McKinney, and J. McDonagh. "Diagnosis of disseminated intravascular coagulation. Role of D-dimer." American journal of clinical pathology 91.3 (1989): 280-287.
Adam, Soheir S., Nigel S. Key, and Charles S. Greenberg. "D-dimer antigen: current concepts and future prospects." Blood 113.13 (2009): 2878-2887.