Question

A 26 year-old female required 12 units packed red blood cells during a trauma resuscitation and surgical repair of liver and splenic lacerations. The patient is now 6 hours postoperative and has blood oozing from the suture line and IV sites. There is bloody urine in the Foley bag. Laboratory evaluation demonstrates a platelet count of 10,000/microliter, prolonged prothrombin level, and the presence of fibrin split products. Which of the following is the most likely diagnosis?

1) acute ABO incompatibility reaction
2) disseminated intravascular coagulation
3) exacerbation of idiopathic thrombocytopenia
4) inadequate repair of the liver lacerations

Answer 1

The most likely diagnosis for the patient is disseminated intravascular coagulation (DIC), characterized by systemic activation of blood coagulation leading to simultaneous bleeding and clotting.

Step-by-step explanation:

The most likely diagnosis for a 26 year-old female who required multiple units of packed red blood cells during a trauma resuscitation and is now experiencing blood oozing from suture line, IV sites, and having bloody urine with a laboratory evaluation showing a platelet count of 10,000/microliter, prolonged prothrombin time, and presence of fibrin split products is disseminated intravascular coagulation (DIC). DIC is a condition characterized by systemic activation of blood coagulation, which results in the formation and eventual depletion of clotting factors and platelets, leading to widespread bleeding and clotting at the same time.

Conditions like acute ABO incompatibility reactions and inadequate repair of liver lacerations have different clinical presentations. For instance, an ABO incompatibility would typically present with symptoms such as fever, chills, and hemoglobinuria shortly after transfusion. An inadequate repair of liver lacerations would more likely localize bleeding rather than cause systemic issues involving both coagulation and bleeding. In this case, the patient's symptoms and laboratory findings are consistent with the consumptive coagulopathy of DIC, not the localized issues or immune reactions of the other conditions listed.