A 25-year-old woman is brought to the emergency department after a motor vehicle collision. She has a pneumothorax, multiple rib fractures, and a right femur and tibial fracture. A chest tube is placed. The patient receives resuscitation and undergoes repair of the femur and tibial fractures. The following day, she develops respiratory distress, decreased urine output, and persistent bleeding from the chest tube drains and around the intravenous lines. Which of the following sets of laboratory findings is most likely to be seen in this patient?

Question

A 25-year-old woman is brought to the emergency department after a motor vehicle collision.  She has a pneumothorax, multiple rib fractures, and a right femur and tibial fracture.  A chest tube is placed.  The patient receives resuscitation and undergoes repair of the femur and tibial fractures.  The following day, she develops respiratory distress, decreased urine output, and persistent bleeding from the chest tube drains and around the intravenous lines.  Which of the following sets of laboratory findings is most likely to be seen in this patient?

Quizplus · Accepted Answer

11ec160b_3976_53d0_9249_f520b4face91_MD0001_00 This patient with multiple injuries following a severe motor vehicle accident developed respiratory distress, reduced renal output, and oozing from the catheter and venipuncture sites. This presentation raises strong suspicion for disseminated intravascular coagulation (DIC), a consumptive coagulopathy associated with trauma, sepsis, malignancy, and obstetrical complications. In DIC due to trauma, the coagulation cascade is triggered by damage to the vascular endothelium (exposes tissue factor) and tissues (releases procoagulant proteins and phospholipids). This leads to the generation of fibrin- and platelet-rich microvascular thrombi, which consumes platelets, coagulation factors (eg, low factor VII), and fibrinogen. Fibrinolysis and anticoagulant proteins then dissolve the clots, which depletes protein C, protein S, and antithrombin. Most patients with acute DIC develop bleeding complications such as oozing from catheters/venipuncture sites, ecchymosis, and petechiae. End organ damage to the kidneys (eg, renal insufficiency) and lungs (eg, pulmonary hemorrhage) is common. Many patients also have microangiopathic hemolytic anemia (eg, schistocytes) due to shearing of red blood cells by intravascular thrombi. Educational objective: Acute disseminated intravascular coagulation is a consumptive coagulopathy linked to severe trauma. Widespread formation of microvascular thrombi leads to consumption of platelets, coagulation factors, and fibrinogen. Subsequent activation of anticoagulant proteins leads to low protein C/S; fibrinolysis elevates D-dimer. Most patients have bleeding complications (eg, oozing from venipuncture/catheter sites) and end organ damage to the lungs or kidneys.

A 25-Year-Old Woman Is Brought to the Emergency Department After