Disseminated intravascular coagulation: Viva

This is the acute, fulminant, thrombosis-dominated disseminated intravascular coagulation of meningococcal sepsis. The structured oral runs from the ISTH score through the cause-driven resuscitation, the components for the bleeding, the heparin for the purpura fulminans, and the anticoagulant evidence. ^[1][2]

Opening: make the diagnosis

Examiner. The platelet count is 38 times ten to the nine per litre, the fibrinogen is 0.8 grams per litre, and the D-dimer is strongly raised. What is the diagnosis, and how do you confirm it? ^[1]

Candidate. This is disseminated intravascular coagulation, an acquired, trigger-driven syndrome of the systemic intravascular coagulation, and the trigger here is the septic shock with the purpura fulminans. I confirm it with the ISTH overt-DIC score, which totals the platelet count, the fibrinogen, the D-dimer, and the prothrombin time. This boy scores two for the platelets under fifty, one for the fibrinogen under one gram per litre, three for the strongly raised D-dimer, and at least one for the prolonged prothrombin time, for a total well above five, the threshold for the overt disease. The fragmented red cells on the film are the microangiopathic haemolysis. ^[1][2]

Examiner (probe). What would make you look for a different trigger? ^[3]

Candidate. The triggers in children are the sepsis, the malignancy, the trauma, and the obstetric and neonatal catastrophes. If the child had the bruising and the pallor with the blast cells on the film, I would suspect the acute leukaemia, especially the acute promyelocytic leukaemia. If the child had the major trauma or the burns, I would recognise the tissue-factor release. The chronic, low-grade picture with the isolated thrombocytopenia would raise the Kasabach-Merritt haemangioma. The trigger drives both the cause treatment and the prognosis. ^[3]