A 30-year-old woman with severe pre-eclampsia at 32 weeks gestation develops abruptio placentae with disseminated intravascular coagulation. Laboratory findings show platelets 45,000/µL, fibrinogen 120 mg/dL, PT 22 seconds, and D-dimer markedly elevated. Which of the following best explains the coagulopathy in this setting?
- A Isolated thrombocytopenia due to increased platelet consumption in the spleen
- B Hemodilution from aggressive fluid resuscitation
- C Consumption coagulopathy with hypofibrinogenemia and prolonged clotting times due to widespread fibrin deposition ✓
- D Impaired hepatic synthesis of clotting factors due to HELLP syndrome
Correct answer: C. Consumption coagulopathy with hypofibrinogenemia and prolonged clotting times due to widespread fibrin deposition
Explanation
Abruptio placentae in severe pre-eclampsia triggers DIC, a consumption coagulopathy characterized by widespread fibrin deposition, consumption of platelets and clotting factors (especially fibrinogen), prolonged PT/aPTT, and elevated fibrin degradation products (D-dimer). The low fibrinogen and prolonged PT confirm this. Option A is incorrect because DIC involves more than thrombocytopenia. Option B is incorrect as hemodilution does not cause this pattern. Option D is incorrect because HELLP does not typically cause hypofibrinogenemia or prolonged PT.
Reference: Williams Obstetrics, 26th ed.
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