Snap Shot A 26-year-old man with multiple fractures and soft tissue injuries from a motorcycle accident has diffuse bleeding from all the needle puncture sites and open wounds on the second day of his hospitalization. His prothrombin time (PT) is 20 seconds (11-15), his partial thromboplastin time (PTT) is 100 seconds (60-85), and his platelet count is 45,000 (150K -450). His D-Dimer assay is positive. Introduction A systemic coagulation disorder with pathologic coagulation with formation of microthrombi lack of physiologic coagulation as coagulation factors are depleted May occur secondary to sepsis transfusion reactions neoplasms ( adenocarcinoma, leukemia) trauma (spills out thromboplastin which activates intrinstic and extrinsic system) obstetric complications abruptio placentae preeclampsia amniotic embolus septic abortion retained dead fetus Presentation Symptoms bleeding from venipuncture sites or incisional wounds epitaxis hematemesis hematuria tachycardia tachypnea respiratory failure petechiae or purpura Evaluation Labs show elevated PT PTT bleeding time fibrin split products D dimer Decreased plateletes (thrombocytopenia) plasma fibrinogen Blood smear shows shistocytes Differential Liver failure, Vitamin K deficiency, TTP DIC ITP TTP HUS fever no no yes no splenomegaly no no yes yes Platelets low low low low bleeding time ↑ ↑ ↑ ↑ PT ↑ - - - PTT ↑ - - - shistocytes yes no yes yes trauma yes no no no Treatment Treat underlying disorder Administer FFP to replace all of the coagulation fractures platelets and cryoprecipitate to replenish the fibrinogen consider heparin for thrombotic complications if refractory try aminocaproic acid, or tranexamic acid Prognosis, Prevention, and Complications Leads to systemic collapse and death if early identificatoin and interverntion are not made