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Disseminated intravascular coagulation — SCE Acute Medicine MCQ

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HardHaematological EmergenciesDisseminated intravascular coagulationSCE Acute Medicine

A 41-year-old woman has confusion, platelets 14 × 10⁹/L, schistocytes, reticulocytosis, undetectable haptoglobin, creatinine 108 micromol/L, INR 1.1 and MCV 86 fL. She has no cancer or transplant history. ADAMTS13 is pending. What is the best immediate plan?

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Correct answer: C — Initiate plasma exchange and glucocorticoid treatment for immune TTP

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

B is correct. She has microangiopathic haemolysis, severe thrombocytopenia, preserved renal function, INR below 1.5, MCV below 90 and no cancer or transplant: a high PLASMIC score and strong suspicion of immune TTP. Send pretreatment ADAMTS13 but begin urgent specialist plasma exchange and glucocorticoids; caplacizumab and rituximab are incorporated according to confirmation and the UK pathway. Platelets are avoided unless life-threatening bleeding, while waiting for ADAMTS13 can be fatal. Complement-HUS treatment is not the first assumption in this phenotype.

Reference: https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.19026