Identify key lab findings in patients with Disseminated Intravascular Coagulation
Disseminated Intravascular Coagulation is especially common in patients whose bodies have already undergone certain traumas. This patient, as they have already undergone a C-section, are at known risk for DIC. While there is nothing notably concerning in their initial workup, given the patient’s history, the medical staff should be actively looking for conditions like DIC to arise.
That said, there are several elements of the blood workup conducted on day four that point to a more significant problem for the patient. While there is not a single test, or set of labwork, use to detect DIC, there are certain blood work results which, when paired with patient history, can be used to diagnose.
In the case of this patient specifically, their lab results from day 4 show a PT or clotting time that is 4 times longer than is acceptable. Correspondingly, INR scores are more than double what is acceptable for a patient on Warfarin, and 6 times higher than are acceptable in a patient who has not had blood thinners (Harris, 2012). PT/INR are the most common lab results used to deduce a DIC diagnosis (British Journal of Health 2009).
The patient’s low Hemoglobin count is also significant in trying to diagnose DIC, as the condition can fragment red bloodcells resulting in a lower overall red blood cell count (British Journal of Health 2009.
How is thrombocytopenia diagnosed?
Thrombocytopenia is diagnosed in much the same way as DIC. First, the patient medical history, and a physical exam are both heavily considered, and then, labs are ordered to confirm. Again, while there is not a single test for the condition a combination of factors and lab results when taken together can be used for diagnosis.
The medical history is useful in determining if there are other causes for symptoms that are common in patients with thrombocytopenia. For example, one of the things that the physical exam will specifically look for is signs of bleeding, including bruises or bloody spots on the skin. However, if the medical history were to reveal that the patient has a history of low platelet counts, or is on blood thinners, it might negate the physical findings (National Heart Lung And Blood Institute, 2012).
Lab results that are considered include a complete blood count, to look at platelet count and condition, and a bone marrow test, or biopsy, to show if the patient’s marrow is making enough blood cells. Finally, a blood smear may be useful to look at the overall condition of individual platelets. (National Heart Lung And Blood Institute, 2012).
If the platelet count is ultimately found to be in the bottom 2.5th percentile of normal platelet distribution, and there is no other explanation for the low blood cell count, like taking blood thinners, or other conditions like AIDS or Hepatitis, then thrombocytopenia is diagnosed (Stasi, 2012).
References:
British Journal of Health (2009). “Guidelines for the diagnosis and management of disseminated.” British Journal of Hematology. 145(1): 24-33.
intravascular coagulation
Harris, N. (2012). “The International Normalized Ratio: How well do we understand this measurement?” National Academy of Clinical Biochemistry.
National Heart, Lung and Blood Institute. (2012). “How Is Thrombocytopenia Diagnosed?” Health Topics.
Stasi, R. (2012). “How to approach thrombocytopenia” ASH Education Book 2012(1):191-197.
