Question

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

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

3) The patient is in state of Diabetes mellitus as her FBS is193 mg/dl.The patient is most likely to have DIC due to coagulopathy.

4)The D Dimer value is increased it is 1500microgram / ml the normal value being 500 microgram / ml.APTT normal range is 30-40s here it is 78.especially.An increase in th level indicates high chance of bleeding .The risk increases many fold as the platelet count is also decreased.NRBS

RBC is decreased because of decreased level of hemoglobin (10)and WBC are elevated

5).The level of fibrinogen is not decreased because of abornormality in coagulation