Disseminated intravascular coagulation: Case

This girl has the acute, fulminant, thrombosis-dominated disseminated intravascular coagulation of meningococcal sepsis. She is in septic shock, with the purpura fulminans and the digital ischaemia, the thrombocytopenia, the prolonged prothrombin time, the low fibrinogen, the strongly raised D-dimer, and the fragmented red cells on the film. The oozing cannula site is the bleeding face of the process, and the purpura fulminans is the thrombotic face. The ISTH overt-DIC score is well above five points. ^[1][2][3]

Interpretation of the findings

The key findings are the septic shock, the bleeding, and the thrombosis, set against the deranged coagulation screen. The platelet count of 34 times ten to the nine per litre is well under the threshold, and the prolonged prothrombin time, the low fibrinogen, and the strongly raised D-dimer together build the ISTH overt-DIC score to well above five points. The fragmented red cells on the film are the microangiopathic haemolysis, the hallmark of the microvascular fibrin shearing the red cells as they pass. The purpura fulminans and the cool dusky digits are the microvascular thrombosis that drives the organ failure. ^[1][2]

The fibrinogen of 0.7 grams per litre is low, and the fellow notes that even a normal fibrinogen in this septic child would not have been reassuring, because the fibrinogen is an acute-phase reactant and an inappropriately normal value may hide the consumption. The diagnosis of disseminated intravascular coagulation is therefore made on the combination of the septic shock, the bleeding, the thrombosis, the deranged screen, and the ISTH score of five points or more, and the management rests on the cause-driven principle. ^[2][3]