Part 1: Disseminated Intravascular Coagulation
Thomas G. DeLoughery, MD, FACP
Dr. DeLoughery is a professor of medicine, Departments of Pathology and Pediatrics, Oregon Health Sciences University, Portland, OR.
A 30-year-old woman who underwent a splenectomy 15 years ago for immune thrombocytopenia is brought to the emergency department by her husband. For the past 24 hours she has had fevers and shaking chills. Her husband brought her in unresponsive. Exam shows a hypotensive woman with necrotic finger tips and toes. Laboratory testing shows markedly elevated international normalized ratio (INR) and activated partial thromboplastin time (aPTT), platelet count of 15,000 cells/μL, and a fibrinogen level of 35 mg/dL. What therapies should be used to manage this patient?