Answer to Case on Thrombocytopenia and Coagulopathy

The above labs show:

Question: Could be DIC and if so, what are the circumstances?

Answer: No single lab test is sufficiently sensitive/specific to diagnose DIC. Diagnosis is facilitated by use of clinical prediction scores, most commonly the ISTH score.

In this case, the ISTH score is:

5 points is compatible with overt DIC. What is unusual about this patient’s labs is that the fibrinogen is so high.

Question: What might explain the high fibrinogen in the setting of DIC?


Case summary:

This was a 33 yo F who presented with septic abortion during the second trimester. She had gram negative bacteremia (speciation is pending) and heavy vaginal bleeding. She underwent D&C and cervical balloon placement, was treated with antibiotics and received pRBC/FFP. Four days later, all her coagulation tests had normalized.

The ISTH DIC score does not perform as well in pregnant women vs. non-pregnant patients. One group adapted the ISTH DIC scoring system for diagnosis of overt DIC for use in pregnant patients (see graphic).

Take home message: of all the markers of DIC, fibrinogen is least sensitive, and this is even more so the case in a patient who is pregnant because their levels normally increase as pregnancy progresses.