04-03-2007, 05:53 PM
A 58-year-old woman is having persistent heavy bleeding from her surgical wound following a mastectomy for carcinoma of breast. Purpura of her arms and truck are noted. Urine output has been only 300 mL in 24 hours. Laboratory studies show hemoglobin 9 gm/dL, white blood cells 16,500/mm3, with 75% polymorphonuclear leukocytes and 12% bands, and platelets 55,000/mm3. Serum urea nitrogen (BUN) is 35 mg/dL, creatinine is 2.8 mg/dL. Coagulation studies reveal a prothrombin time of 18 seconds and an activated partial thromboplastin time of 50 seconds. Fibrinogen is 150 mg/dL, thrombin time is prolonged, fibrin degradation products are 30 micrograms/dL (normal <10), D-Dimer is 600 micrograms/L (normal <250). Urinalysis shows numerous red cells in the sediment. Which of the following is the most likely diagnosis?
(A) Disseminated intravascular coagulation (DIC)
(B) Dysfibrinogenemia
© Hemolytic uremic syndrome
(D) Idiopathic thrombocytopenic purpura (ITP)
(E) Inadequate surgical hemostasis, with consumption of clotting factors due to hemorrhage
(A) Disseminated intravascular coagulation (DIC)
(B) Dysfibrinogenemia
© Hemolytic uremic syndrome
(D) Idiopathic thrombocytopenic purpura (ITP)
(E) Inadequate surgical hemostasis, with consumption of clotting factors due to hemorrhage