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Massive transfusion coagulopathy — SCE Acute Medicine MCQ

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EasyHaematological EmergenciesMassive transfusion coagulopathySCE Acute Medicine

A 82-year-old woman presents with fever, bleeding, thrombosis or severe anaemia. Relevant history includes malignancy, chemotherapy, haemoglobinopathy or anticoagulant exposure. On assessment, blood film and coagulation results are abnormal. Investigations show ongoing bleeding with hypothermia, acidosis, thrombocytopenia and low fibrinogen. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Activate major haemorrhage protocol with plasma, platelets and fibrinogen replacement

The key discriminator is that ongoing bleeding with hypothermia, acidosis, thrombocytopenia and low fibrinogen, which makes Activate major haemorrhage protocol with plasma, platelets and fibrinogen replacement the single best answer. Give intravenous fluids with reassessment is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE NG24; BSH major haemorrhage guidance