Veldora is a 63-year-old female that was brought to the emergency room (ER) in acute respiratory...

Veldora is a 63-year-old female that was brought to the emergency room (ER) in acute
respiratory distress. She was showing signs of sepsis including hypotension, tachycardia,
and a temperature of 39oC. Her lactic acid level and white blood cell (WBC) count came
back elevated. She was admitted to the intensive care unit (ICU) with a diagnosis of
severe sepsis secondary to pneumonia. She was put on vancomycin, ceftriaxone,
levophed and morphine for pain. Veldora had to be intubated on her second day while in
the ICU and was put on propofol. During the afternoon of the second day, the nurse
noticed hematuria, petechiae, and blood tinged secretions. A coagulation study was
ordered and showed a positive d-dimer, prolonged prothrombin time (PT) and activated
partial thromboplastin time (aPTT) and a platelet count of 75,000. As a medical scientist,
evaluate your investigation.

Expert Solution

The coagulation study of the patient shows:

Positive d-dimer, prolonged PT and activated partial thromboplastin time (aPTT), decreased platelet count ( 75000)

This is an abnormal condition.

d- dimer is a protein fragment which can be seen in the blood after fibrinolysis (degradation of blood clot) of a blood clot. It is a fibrin degradation product. Normal d- dimer value is less than 0.50. An elevated d-dimer value represents that there is significant formation and degradation of blood clots in the patient's body.

During sepsis, the antithrombin( ie, coagulation inhibitor) is lowered due to reduced protein synthesis and increased clearence. Along with that the factor XII is very low in septic condition which leads to prolonged aPTT

Elevated PT represents hypocoagulable state.

Also in septic patients marked decrease in the platelet can be seen because of the endothelial damage, production of many cytokines and bone marrow suppression.

Nightingale answered 2 years ago

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