Question

Part II:

A 35-year-old woman is in the intensive care unit with sepsis following a cesarean section.

                                                                        Manual differential:

WBC                 4.3                                         Band neutrophils        25

RBC                3.20                                         Seg neutrophils           45

Hgb                 10.0                                        Lymphs                      10

Hct                  29.8                                         Monos

MCV               93.2                                         Eos

MCH              31.5                                         Basos

MCHC    34.5   Metamyelocytes         15

RDW               17.9                                         Myelocytes                5

PLT                 10.0                                         Promyelocytes

                                                                        Marked toxic granulation

NRBCs           9/100 WBCs

PT:                  42.4 sec

APTT:                        78.3 sec

The results of the proposed additional studies were as follows:

FBG                193 mg/dL

D-dimer             1.5 μg/mL

1.         Describe the peripheral blood findings.

            

2.         Interpret the coagulation screening tests.

            

3.         Based on all the data provided, what condition is most likely?

            

4.         What information is most diagnostic?

5.         Why is the fibrinogen not decreased in this case?

Answer 1

1. In the peripheral blood findings , patient is having low platelets counts 10000 ,which should be between 1.5 lakh to 4.5 lakh and because of this her pt and aptt values are increased as the blood is taking more time to clot due to insufficient platelets .

Normal pt range = 10 to 13 secs

Normal aptt range is 60 to 70 secs

Her hemoglobin is also less it's 10gm/ dl , it should be 14-16gm/dl due to excessive bleeding and less platelets

She is neutropenic also as her neutrophils are 45 % ,it should be between 60 to 70 %

Her fasting blood glucose level is also high 193 mg/dl which is more than the normal range of 126 mg/dl hence ,she has diabetes .

D- dimer range is increased above normal reference range of 0.5

2.Her pt and aptt value are increased above normal ranges due to platelet and other clotting factor deficiency ( her platelets are 10000,normal range is 1.5 to 4.5 lakh) as a result of which her hemoglobin has dropped down due to bleeding .

Normal pt is 10 to 13 secs

Normal aptt is 60 to 70 secs

3. Disseminated intravascular coagulopathy, because the d - dimer value is 1.5 which is more than the reference range of 0.5 and it has lead to thrombocytopenia and altered coagulation and causing multiple organ damage . DIC is a condition in which blood clots form through out the body blocking small vessels . In this case it is triggered by sepsis.

4. The D - dimer test and coagulation test is the most informative information provided to make the diagnosis .