DIC question...

[babuchuck]

1.A 32 yo man is brought to emergency department 20 minutes after having a generalized tonic-clonic seizure. He has a 24 hour history of fever, headache, and intolerance of light. He is alert. His temperature is 40C (104F), pulse 140/min, respirations 24, and BP 90/55. He appears acutely ill. Neuro exam shows no focal findings. IV fluids are administered and there is persistent bleeding around the IV site. Lab studies show:
PT 16 sec (INR 1.1)
PTT 33 sec
Fibrin degredation products increased
D-dimer increased
Which of the following changes is most likely in the blood coagulation process of this patient?
i.Decreased fibrinolysis
ii.Decreased microvascular thrombus formation
iii.Decreased thromin production
iv.Increased circulating clotting factor
v.Increased plasmin generation
vi.Increased platelet count


I get that it's DIC but wouldn't his PT/PTT be increased in that case?

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[whoknows2012]

Yes I found it odd but in terms of the answer choices only one choice truly made sense. Increased plasmin generation hence the increased fibrin degradation products and increased D-dimer. Had it said increased instead of decreased fibrinolysis I guess that could've worked too.

 

[RafaTech]

1.A 32 yo man is brought to emergency department 20 minutes after having a generalized tonic-clonic seizure. He has a 24 hour history of fever, headache, and intolerance of light. He is alert. His temperature is 40C (104F), pulse 140/min, respirations 24, and BP 90/55. He appears acutely ill. Neuro exam shows no focal findings. IV fluids are administered and there is persistent bleeding around the IV site. Lab studies show:
PT 16 sec (INR 1.1)
PTT 33 sec
Fibrin degredation products increased
D-dimer increased
Which of the following changes is most likely in the blood coagulation process of this patient?
i.Decreased fibrinolysis
ii.Decreased microvascular thrombus formation
iii.Decreased thromin production
iv.Increased circulating clotting factor
v.Increased plasmin generation
vi.Increased platelet count


I get that it's DIC but wouldn't his PT/PTT be increased in that case?

According to Goljan (in his audio), he said the full blown text book presentation of DIC hardly ever happens. With that being said, there still is only one answer really makes sense which is the increase plasmin generation. I know its kind of tricky, but thats what the question writers are trying to do...

 

[kaleerkalut]

DIC would not elevate PT and PTT (from what I learned) because it would not consume any factors in an unbalanced fashion. All factors are consumed as the entire cascade is used up (it is a consumptive process). PT and PTT should not be elevated (although bleeding time should be).

 

[whoknows2012]

DIC would not elevate PT and PTT (from what I learned) because it would not consume any factors in an unbalanced fashion. All factors are consumed as the entire cascade is used up (it is a consumptive process). PT and PTT should not be elevated (although bleeding time should be).

Balanced or unbalanced its the consumption of clotting factors in the massive intravascular coagulation (hence dIC) that occurs which would lead to increased PT, PTT and bleeding times. In the question above its clear there is only one good answer but in a "textbook" case of DIC (as Rafatech said above) all bleeding indices will be elevated.

http://www.merckmanuals.com/professional/sec11/ch136/ch136b.html