QuestionSBA
QuestionChoice
Acute cholangitis may rarely cause a mild coagulopathy due to cholestasis, however, the history of an infection causing sepsis and profound coagulopathy is more in keeping with DIC.
10035981
e
Liver dysfunction
QuestionChoice
HELLP (Haemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a life-threatening pregnancy complication that may occur in the late second/third trimesters of pregnancy. It is often associated with pre-eclampsia/eclampsia.
10035980
d
HELLP syndrome
QuestionChoice
Evolving coagulopathy and oozing at line sites/mucosal bleeding in the context of an acute illness should raise suspicions of DIC. A blood film, d-dimer, and fibrinogen levels would be useful to confirm the diagnosis.
10035977
a
Disseminated intravascular coagulation (DIC)
QuestionChoice
HUS causes microangiopathic haemolytic anaemia like DIC, however, it often presents after infection with a Shiga-toxin-associated E. coli strain. Patients with HUS may present with bloody diarrhoea. Sepsis followed by coagulopathy is more typical of DIC than HUS.
10035979
c
Haemolytic uraemic syndrome (HUS)
QuestionChoice
TTP causes microangiopathic haemolytic anaemia like DIC, however it often presents with renal dysfunction and neurological signs. Intercurrent sepsis makes DIC a more likely diagnosis. Further, deranged PT/APTT are more commonly seen in DIC than TTP.
10035978
b
Thrombotic thrombocytopenic purpura (TTP)
Concept
Chapter
2693
6175
Disseminated intravascular coagulation (DIC)
Topic
157
Haematology
19599
Disseminated intravascular coagulation (DIC) presents with coagulopathy and bleeding in the context of severe systemic illness.
An 82-year-old man is admitted to hospital with right upper quadrant pain, jaundice, and fevers. A CT abdomen shows evidence of cholangitis and he is admitted for antibiotics and a planned ERCP.

Routine clotting studies show a mildly prolonged prothrombin time and mild thrombocytopenia.

Over the day, he becomes profoundly septic and it is noted that he is bleeding from his cannula site. Repeat blood tests show worsening thrombocytopenia and coagulopathy, as well as new anaemia.

What is the most likely diagnosis?
a