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Sepsis-associated disseminated intravascular coagulation — SCE Acute Medicine MCQ

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HardCancer, palliative care and haematologySepsis-associated disseminated intravascular coagulationSCE Acute Medicine

A 71-year-old man with chronic lymphocytic leukaemia is brought in with fever, hypotension and confusion. Platelets are 42 × 10^9/L, INR 2.1, fibrinogen 0.8 g/L and D-dimer is markedly elevated. Blood film shows no blasts. He has purpura around cannula sites. What is the most likely diagnosis?

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Correct answer: B — Disseminated intravascular coagulation secondary to sepsis

Thrombocytopenia with prolonged clotting, low fibrinogen, raised D-dimer and bleeding in severe infection is typical of DIC. TTP causes thrombocytopenia and microangiopathic haemolysis but usually has normal clotting tests. Vitamin K deficiency can prolong PT but does not explain low fibrinogen and high D-dimer in this clinical context.

Reference: British Society for Haematology DIC Guideline