A 47-year-old fireman is admitted to the emergency room for extensive burns received while battling a fire. A few hours after admission, he develops pregangrenous changes in multiple digits of hands, his left foot, and his nose. A short time later, he experiences bleeding from his mucous membranes and IV site, as well as the development of multiple petechiae. Which of the following is the major initiating mechanism of this clinical scenario?

Question

Quizplus · Accepted Answer

The clinical scenario describes disseminated intravascular coagulation (DIC), which is often initiated by the release of thromboplastin (tissue factor) into the circulation, leading to widespread clotting and subsequent bleeding. This patient is exhibiting the typical findings of disseminated intravascular coagulation. This is initiated by the release of tissue factor or thromboplastic substance (either exogenous, eg, amniotic fluid, or endogenous, eg, tissue damage as in this case) into the circulation. This activated the coagulation cascade, resulting in the formation of multiple thrombi that can block the microcirculation and produce ischemia and necrosis in vulnerable tissues. As thrombus formation continues, platelets and clotting factors can be exhausted, allowing hemorrhage to occur. The ischemic changes and hemorrhage are both apparent in this patient. Given the history and timing of this case, trauma leading to the release of tissue factor is more likely. However, endothelial injury may also initiate disseminated intravascular coagulation (DIC) by the release of tissue factor.

A 47-Year-Old Fireman Is Admitted to the Emergency Room for Extensive