Question 116

Question:

On your rotation in the intensive care unit, you follow a patient with advanced sepsis from a central line infection. On exam you notice marked petechiae on his extremities as well as some large clots around his mouth. Concerned about disseminated intravascular coagulation, you check his labs. What would you expect?

Correct Answer: B.  Low platelets, high bleeding time, high PT, high PTT

The basis of disseminated intravascular coagulation is excessive consumption of clotting factors and platelets to the point where bleeding can no longer be stopped. Thus you see a paradox of clotting and bleeding in the same clinical picture. The consumption of coagulation factors and platelets leads to prolonged PT and PTT as well as a low platelet count. Bleeding time is determined mainly by platelet count–the fewer platelets, the longer it takes for the platelet plug to be formed, the longer the bleeding time.