Medical Question of the Day- 21




A 62 year-old man complains of fever and diminished consciousness for 2 days. He has been healthy all his life and he doesn’t take any medications. On examination, he responds inconsistently to commands. His temperature is 103 F, pulse 110/min and blood pressure is 80/56 mmHg. His physical examination is otherwise normal. There is no bleeding. Laboratory test are as follows:

Hemoglobin: 12 g/dl

Leukocyte count: 25,000 – 80% neutrophils

Platelet count: 20,000

D-dimer is high

Fibrinogen level is low

What is the most likely diagnosis?

A – Idiopathic thrombocytopenic purpura

B – Thrombotic thrombocytopenic purpura

C – Disseminated intravascular coagulation

D – Hemophilia a

E – Hemophilia b

Answer




This patient most likely has sepsis leading to disseminated intravascular coagulation. It is confirmed by increased D-dimer and low level of fibrinogen. He has been healthy all his life so, acute infection leading to sepsis is the most likely etiology while major conditions that usually show up in younger age as purpura and hemophilia are not likely associated with this man’s condition.

The correct answer is C

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78 thoughts on “Medical Question of the Day- 21”

  1. C, dic

    We see a drop in fibrinogen,platelets and a high d dimer. Indicates simultaneous coag as well as breakdown. Cause could be sepsis indicated by high leucocytes and neutrophils and fever. The patient has a low bp and also had decreased conciousness which could be due to septicemia and shock. The patient could have had a severe infection leading to dic and shock. To treat we would restore bp and give antipyretics as well as ffp to restore the coagulation factors (loss due tk onverconsumption). If it developed slowly we give heparin

  2. C dic:
    d dimers high and also platelets low and fibrinogen low. fever and leucocytes point to infection so sepsis or sever infection lead to pre Dic which progressed to dic. Theres overconsumption of coag factors. The sepsis could have led to shock which could explain the lowered bp and the neuro symptomps (decreased conciousness)

    Bp would need to be restored maybe anti pyretics for fever and treat the cause (sepsis?) Also could give slow infusion of heparin if it was slow evolving. Give ffp to restore coag factors.

  3. It is sepsis induced delirium that’s why neurological symptoms and sepsis has led to DIC .. so answer is DIC

  4. A normal Hb value is unlikely for the TTP.

    Increased D-Dimer and decreased fibrinogen->(c)DIC

    Would go for C- DIC.

  5. The answer is B is thrombotic thrombocytopenic purpura.
    Because DIC .haemphiliae will not present with neurological symptoms like this.and presence of decrease conciousness or any neurological symptoms support diagnosis of TTP rather than ITP

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