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Disseminated intravascular coagulation in sepsis — SCE Acute Medicine MCQ

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HardCancer, palliative care and haematologyDisseminated intravascular coagulation in sepsisSCE Acute Medicine

A 70-year-old man with pneumonia deteriorates with bleeding from cannula sites and mottled skin. Platelets fall to 38 x 10^9/L, PT and APTT are prolonged, fibrinogen is 0.8 g/L and D-dimer is markedly raised. Lactate is 5.4 mmol/L. What is the most likely diagnosis?

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Correct answer: C — Disseminated intravascular coagulation secondary to sepsis

The combination of sepsis, thrombocytopenia, prolonged clotting times, low fibrinogen and high D-dimer is classic for DIC. TTP causes microangiopathic haemolysis and thrombocytopenia but usually has a normal coagulation screen. Management focuses on treating sepsis and supporting bleeding or procedural needs with blood products guided by haematology.

Reference: BSH guideline on disseminated intravascular coagulation; NICE NG253 sepsis