Nov 16, 2015
78
4
Status
  1. Attending Physician
So reading a forum I saw someone asking about this question:

Guy comes in after a seizure, has no history but physical exam suggests meningitis. He has bleeding around the site of IV fluid administration and they do lab tests: PT, PTT, fibrin degradation products, and D-dimer are all INCREASED. What is wrong in the blood coag of this patient?

So the patient clearly has DIC, but I think all the answers but one, all are wrong. These are the different options and my explanation about each one, please help me out tell me if i'm wrong:

Decreased fibrinolysis FALSE, it is increased, in order to form plasmin which then cleaves fibrin, fibrinogen, etc. And is the reason why those are decreased.
Decreased microvascular thrombus formation. False, this is increased by definition, and is the reason why there's ischemia and infarctation.
Decreased thrombin production. False, it is the final product of the coagulation cascade, which is pathologically activated.
Increased circulating clotting factors. False, they are decreased because they are being used, thus being consumed.
Increased plasmin generation. TRUE? In order to then decrease fibrin and fibrinogen, and coag factors
Increased platelet count FALSE, they are decreased by consumption.

According to pathoma: In DIC, there's a pathologic activation of the coagulation cascade, thus, there will be widespread microthrombi causing ischemia and infarctation, aswell as COMSUMPTION of platelets and coagulation factors. The coagulation cascade generates thrombin, that will be used to convert fibrinogen into fibrin to stabilize the now called platelet-fibrin thrombus.This means both coag factors and platelets will be decreased, for that same reason PT and aPTT and Bleeding time will be increased. Microangiopathic hemolytic anemia can be found aswell, and fibrinogen will be decreased due to consumption, being transformed into fibrin, and as a result of this fibrin split as part of the fibrinolysis process, fibrin split products will be increased, all of them, including D-DIMER, which is the best screening test for DIC.
 
Sep 8, 2015
283
334
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Status
  1. Pre-Health (Field Undecided)
IMO increased plasmin is true , since you get widespread activation of both fibrinolytic AND clotting systems , and the fibrinolytic system is initially activated via turning plasminogen to plasmin
 
Nov 16, 2015
78
4
Status
  1. Attending Physician
Yeah that's why I thought the question stem was wrong and it should say which one is true :) thanks
 
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