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DIC — RACP Adult Medicine MCQ

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ModerateHaematologyDICRACP Adult Medicine

A 60-year-old man with metastatic prostate cancer develops widespread petechiae, mucosal bleeding, and oozing from IV sites. Platelets 35 × 10⁹/L, PT 22 s (prolonged), APTT 55 s (prolonged), fibrinogen 0.6 g/L (very low), D-dimer massively elevated. Blood film shows schistocytes. What is the most likely diagnosis?

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Correct answer: C — Disseminated intravascular coagulation

Thrombocytopenia with prolonged PT/APTT, very low fibrinogen, massively elevated D-dimer, and schistocytes in the context of metastatic cancer is DIC. Key differentiator from TTP: DIC has abnormal coagulation (low fibrinogen, prolonged PT/APTT, elevated D-dimer) while TTP has normal coagulation. Treatment: address underlying cause (cancer treatment), replace consumed factors (cryoprecipitate for fibrinogen <1.5, FFP for coagulation factors, platelets if <20 or bleeding).

Reference: BSH – 2024 – DIC; ISTH 2024 DIC