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Disseminated intravascular coagulation in septic shock — SCE Acute Medicine MCQ

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HardHaematological EmergenciesDisseminated intravascular coagulation in septic shockSCE Acute Medicine

A patient with septic shock has platelets 35 × 10^9/L, prolonged PT and APTT, fibrinogen 0.7 g/L, very high D-dimer and oozing from lines. Which management principle is correct?

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Correct answer: C — Treat sepsis and target components to active bleeding

The best answer is “Treat sepsis and target components to active bleeding”. This is correct because disseminated intravascular coagulation is controlled primarily by reversing its trigger. Active bleeding with severe hypofibrinogenaemia may require targeted cryoprecipitate or fibrinogen replacement and other components. Routine correction of laboratory values, reflex anticoagulation and delayed source control misunderstand the consumptive process.

Reference: British Society for Haematology DIC guideline: https://pubmed.ncbi.nlm.nih.gov/19222477/