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DIC — RACP Adult Medicine MCQ

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ModerateHaematologyDICRACP Adult Medicine

A 60-year-old man with DIC presents with oozing from IV sites, petechiae, and bleeding gums. FBE shows Hb 88 g/L and platelets 35 × 10⁹/L. Coagulation studies: PT 22 s (normal <14), APTT 55 s (normal <38), fibrinogen 0.8 g/L (normal 2.0–4.0), D-dimer >10 mg/L. Blood film shows schistocytes. He has E. coli septicaemia. What is the most appropriate management?

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Correct answer: E — Platelet transfusion plus FFP plus cryoprecipitate plus treat underlying cause

Acute DIC with bleeding requires multimodal support: platelets (target >50 × 10⁹/L if bleeding), FFP (replace clotting factors), and cryoprecipitate (to raise fibrinogen >1.5 g/L). Critically, the underlying cause (E. coli sepsis) must be treated aggressively. Heparin is reserved for DIC with predominant thrombosis (not haemorrhagic DIC).

Reference: BSH – 2024 – DIC Guidelines; ISTH 2024 DIC Scoring