Question

35 year old female was admitted to the hospital to deliver. the pregnancy had been uneventful. this was her first pregnancy. during delivery, she began to bleed very heavily. she was not on any medication.

Lab results

PT 30 sec

APTT 70sec

Platelet count 25,000

fibrinogen 350mg/dl

1. what is the cause of the prolonged PT and APTT?

2. what is the cause of the decreased platelet count?

3. what additional laboratory tests are indicated and what would the expected result be?

4. explain the elevated fibrinogen level?

5. what is causing the patient to bleed?

6. what type of treatment should be done?

Answer 1

1. The common causes of prolonged PT and APTT are the use of oral anti coagulants, disseminated intravascular coagulopathy(DIC),vitamin K deficency, and liver disease. There are some other causes like coagulation factor deficiencies, coagulation factor inhibitors and diffuse intra vascular coagulation.

In this case she has PPH and prolonged PT and APTT are indicative of DIC. In DIC, PT and APTT both are prolonged with decreased platelet and fibrinogen

2. Thrombocytopenia in this case can be suggestive of pre eclampsia or any condition accompanied by DIC. It is mentioned that, the pregnancy was uneventful and there is no suggestion of pre-eclampsia and eclampsia in this case. Therefore, it is suggestive of DIC.

3. Other tests include D-Dimer and INR, positive D dimer is another indicator of DIC and increased INR value.

4. Usually in DIC the fibrinogen level is decreased but in response to bleeding, level of fibrinogen can be increased to increase the viscosity and clotting as well as in the pregnancy period it is expected to be elevated.