Which of the following is involved when there is excessive bleeding after labor, and the laboratory studies demonstrate decreased platelets, prolonged prothrombin time and partial thromboplastin time, and increased fibrin split products?
This is a description of disseminated intravascular coagulation (DIC), a feared and often lifethreatening complication of many other disorders, including amniotic fluid embolism, infections (particularly gram negative sepsis), malignancy, and major trauma. This is suspected when a decrease in platelets and a prolongation of PT and PTT times are observed. The observed hematologic abnormalities are caused by consumption of platelets and clotting factors, caused by extensive microclot formation with accompanying fibrinolysis (reflected by the increased fibrin split products).
Hemophilia (choice B) alters the PTT without affecting the other indices.
Severe liver disease (choice C) produces alterations comparable to those in vitamin K deficiency; platelets can also be decreased secondary to a generalized metabolic marrow dysfunction, but fibrin split products would not be increased.
Vitamin K deficiency (choice D) is associated with alterations in PT and PTT, but platelets will not be decreased, nor will fibrin split products be increased.
Von Willebrand's disease (choice E) produces impaired platelet adhesion and increases the bleeding time and the PTT, but will not produce the other features described.
Disseminated intravascular coagulation
Hemophilia A
Severe liver disease
Vitamin K deficiency