Question
A 26 year old women with third degree burns developed septic shock. With 24hours she was bleeding from all needle puncture sites, with extensive ecchymoses and petechiae and GI Bleeding. Lab studies showed Hb- 6gm/dl., platelet count 64000/cu mm., PT 20 seconds, PTT 50 seconds and D-dimer Positive.
The drop in the amount of Hemoglobin is mostly due to
Answer
Correct answer: b) Acute blood loss
Given the acuity of this presentation (within 24 hours) with bleeding from multiple sites — needle punctures, extensive ecchymoses/petechiae, and GI bleeding — the marked drop in haemoglobin (6 g/dL) is best explained by acute blood loss from the widespread haemorrhagic manifestations of DIC, rather than ineffective erythropoiesis, marrow aplasia, or nutritional deficiency, none of which could develop or account for such a precipitous fall within this short a time frame. (Microangiopathic haemolysis from fibrin-strand-mediated red cell fragmentation also contributes to the anaemia in DIC, but the overwhelming, multi-site acute bleeding is the dominant mechanism in this scenario.)