Question

A 19 year-old girl was admitted to the hospital with a diagnosis of herpes encephalitis and treated for 10 days with antiviral agents and numerous antibiotics and seizure drugs. The patient has been unable to eat and has been maintained on IV fluids. The patient recently began to bleed from venipuncture sites.

INITIAL COAGULATION STUDIES:

PT: 28.8 seconds

APTT: 48.0 seconds

Platelet count: 276,000 mm³

Fibrinogen: 200 mg

D-dimer: <0.02

1. What is the most likely diagnosis and why?
2. Did the antibiotics contribute to the problem? If so, How?

3. ADDITIONAL LABORATORY TESTS:
   

   Factor V assay: 90%

   Factor VII assay: 10%

   Factor IX assay: 45%

   Factor X assay: 35%

4. Why is the factor V in the normal range?
5. What diagnosis is certain now?
6. How would you treat this coagulation problem?

Answer 1

In the present scenario, A 19-year-old girl was admitted to the hospital with a diagnosis of herpes encephalitis and treated for 10 days with antiviral agents and numerous antibiotics and seizure drugs. The patient has been unable to eat and has been maintained on IV fluids. The patient recently began to bleed from venipuncture sites.

The initial coagulation studies shows :

PT: 28.8 seconds

APTT: 48.0 seconds

Platelet count: 276,000 mm³

Fibrinogen: 200 mg

D-dimer: <0.02

These values indicate that the child is suffered from Disseminated intravascular coagulopathy where, Disseminated intravascular coagulation (DIC) is a serious, sometimes life-threatening condition in which the proteins in the blood involved in blood clotting become overactive. Blood clots form in small blood vessels throughout the body. This can disrupt normal blood flow to organs such as the kidneys and liver and can lead to organ failure shows the coagulation problem with excessive bleeding.

Here may be the risk factor for the DIC is the infection with the herpes virus

ADDITIONAL LABORATORY TESTS:

Factor V assay: 90%

Factor VII assay: 10%

Factor IX assay: 45%

Factor X assay: 35%

The results show that the patient is suffered from acquired hemophilia thus the Factor V assay shows it as normal or 90%. To treat the condition we can choose an immunosuppressive therapy.