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.

Question 3

A hematologist is asked to consult on a thrombocytopenic 23-year-old woman who is 38 weeks pregnant. She has elevated results on liver function tests, a low platelet count, an elevated D-dimer level, and schistocytes on her blood smear. Results of hepatitis testing are negative and her ammonia level is normal. What is the most appropriate diagnosis and treatment plan for this patient?

  •  Acute fatty liver of pregnancy and immediate delivery
  •  Acute fatty liver of pregnancy and infusion of recombinant
    3-hydroxyacyl-CoA dehydrogenase before delivery
  •  Amniotic fluid embolism and immediate delivery
  •  HELLP syndrome and immediate delivery
  •  HELLP syndrome and stabilization of the patient
    with plasma exchange before delivery

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