Haematology: disseminated intravascular coagulation: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Haematology: disseminated intravascular coagulation

Sample item

A 40-year-old woman with Gram-negative sepsis from pyelonephritis has oozing from venepuncture sites and haematuria. PT is 24 s (control 13), aPTT 62 s, platelets 38,000 per microlitre, fibrinogen 80 mg/dL, D-dimer is markedly raised and the film shows schistocytes. What is the most important step in management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Treat the underlying sepsis with antibiotics and source control, with component support for bleeding

DIC is a consumptive coagulopathy driven by an underlying disorder, here sepsis. Management is to treat the trigger, and give platelets, fresh frozen plasma or cryoprecipitate only if there is bleeding or an invasive procedure. Heparin is reserved for predominantly thrombotic forms, and antifibrinolytics are generally avoided because they risk microvascular thrombosis.

Option by option

  • A. Treat the underlying sepsis with antibiotics and source control, with component support for bleeding (correct)

    Correct. Removing the stimulus is the only way to stop the consumption of clotting factors.

  • B. Vitamin K alone

    Vitamin K alone does not correct consumption of factors and fibrinogen.

  • C. Tranexamic acid to stop the bleeding

    Antifibrinolytics can precipitate microvascular thrombosis and organ failure in DIC.

  • D. Heparin infusion in all patients

    Heparin would increase bleeding in a patient already haemorrhaging.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Treat the underlying sepsis with antibiotics and source control, with component support for bleeding. DIC is a consumptive coagulopathy driven by an underlying disorder, here sepsis.

Why is "Vitamin K alone" not the answer?

Vitamin K alone does not correct consumption of factors and fibrinogen.

Why is "Tranexamic acid to stop the bleeding" not the answer?

Antifibrinolytics can precipitate microvascular thrombosis and organ failure in DIC.

Why is "Heparin infusion in all patients" not the answer?

Heparin would increase bleeding in a patient already haemorrhaging.

What concept does this question test?

It tests Haematology: disseminated intravascular coagulation in General Medicine. Management is to treat the trigger, and give platelets, fresh frozen plasma or cryoprecipitate only if there is bleeding or an invasive procedure. Heparin is reserved for predominantly thrombotic forms, and antifibrinolytics are generally avoided because they risk microvascular thrombosis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: disseminated intravascular coagulation?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.