A 72-year-old man with a history of chronic atrial fibrillation on warfarin anticoagulation and a questionable history of immune-mediated heparin-induced thrombocytopenia was admitted for elective abdominal surgery. His warfarin anticoagulation was bridged with argatroban in the peri-operative period. Two days after the procedure, a DIC/ICF profile was ordered due to a fall in platelet count and hematocrit and operative site oozing. The results of the coagulation laboratory studies are shown below.
|Prothrombin time (PT)||25.1||sec||10.3 – 12.8|
|PT 1:1 mix||14.5||sec||10.3 – 12.8|
|Activated partial thromboplastin time (APTT)||58||sec||26 - 36|
|APTT 1:1 mix||50||sec||26 - 36|
|Dilute Russell viper venom time (DRVVT) screen ratio||2.3||ratio||0.0 – 1.1|
|DRVVT mix ratio||2.0||ratio||0.0 – 1.1|
|DRVVT confirm ratio||0.9||ratio||0.0 – 1.1|
|Thrombin time (TT)||276||sec||15 - 23|
|Reptilase time (RT)||17||sec||14.0 – 23.9|
|Clauss fibrinogen||125||mg/dL||200 – 430|
|PT-derived fibrinogen||480||mg/dL||261 - 595|
|D-dimer||750||D-dimer units (DDU)||0 - 250|
|Soluble fibrin monomer complexes (SFMC)||<8||mcg/mL||0.0 – 7.9|
|Jansen Seheult, M.B., B.Ch., B.A.O.
Resident, Special Coagulation
|Nahla Heikal, M.D.
Senior Associate Consultant, Hematopathology