A 2-year-old child in shock has multiple non-blanching purple lesions of various sizes scattered about on the trunk and extremities; petechiae are noted, and oozing from the venipuncture site has been observed. The child's peripheral blood smear is shown below. Clotting studies are likely to show which of the following?
The clinical history and blood smear findings (fragmented cells and few platelets) presented in the question are typical of DIC. The disorder, which can be triggered by endotoxin shock, results ultimately in the initiation of the intrinsic clotting mechanism and the generation of thrombin (prolonged PT and PTT, decreased fibrinogen concentration, and an increase in fibrin split products). Fibrin deposited in the microcirculatory system can lead to tissue ischemia and necrosis, further capillary damage, release of thromboplastic substances, and increased thrombin generation. Simultaneous activation of the fibrinolytic system produces increased amounts of fibrin split products, which inhibit thrombin activity. Of utmost importance in the treatment of children who have DIC is the management of the condition that precipitated the disorder.
Increased levels of factors V and VIII
A decreased prothrombin level
An increased fibrinogen level
The presence of fibrin split products
Blood