Disseminated Intravascular Coagulation

Scattered

Step 1: View clinicals

A 37 year old woman at 30 weeks of her first pregnancy presents with severe abdominal pain and profuse vaginal bleeding for 45 minutes. Her pregnancy has progressed normally until now. There is no personal or family history of bleeding tendencies, and her medical history is unremarkable. A cardiotocograph (CTG) shows a baseline heart rate of 170 bpm, and 6 uterine contractions within 10 minutes. No decelerations are seen. An ultrasound scan demonstrates a partially separated anterior placenta, with intra-placental hemorrhage.


Step 2: Order all relevant investigations

Full Blood Count

WBC: 11,600/mm3 (4000-11,000) N: 76% (50-70) L: 21% (20-40) Hb: 7.4 g/dL (11.5-17.5) Hematocrit: 22.2% (36-44) Platelets: 42,000/mm3 (150,000-400,000)

Group & Crossmatch Blood

Group: O positive 4 units of blood crossmatched.

Coagulation Profile

aPTT: 93 seconds (30-40) PT: 40 seconds (10-12) Fibrinogen: 146 mg/dL (373- 619 in 3rd trimester)

Quantitative D-Dimer Assay

D-Dimers: 8805 ng/mL (≤250)


Step 3: Select appropriate management

Urgent Delivery
Blood Transfusion
Corticosteroids Stat
Recombinant Protein C stat


Score: ★★☆