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Disseminated intravascular coagulation — SCE Acute Medicine MCQ

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HardHaematological EmergenciesDisseminated intravascular coagulationSCE Acute Medicine

A septic patient with disseminated intravascular coagulation is bleeding from lines. Platelets are 34 × 10⁹/L, fibrinogen 0.7 g/L, PT is prolonged and haemoglobin is falling. Alongside source control, which haemostatic support is most appropriate?

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

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Correct answer: C — Give platelets and fibrinogen replacement guided by bleeding and repeat tests

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

A is correct. Treating the underlying sepsis is fundamental, but active bleeding with platelets below 50 × 10⁹/L and severe hypofibrinogenaemia supports platelet transfusion and fibrinogen replacement with cryoprecipitate or concentrate according to the major-haemorrhage protocol, followed by clinical and laboratory reassessment. Components are not given merely to normalise tests in a non-bleeding patient. Antifibrinolytic treatment, therapeutic heparin and recombinant factor VIIa are not routine substitutes for source control and targeted replacement in bleeding DIC.

Reference: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2009.07600.x