A trauma patient receives 20 units of packed red blood cells and 4 units of fresh frozen plasma during damage-control laparotomy. After warming the patient and correcting hypocalcemia, oozing persists from surgical sites. Platelet count is 38,000/µL. What is the primary mechanism of coagulopathy in this scenario?

• A Disseminated intravascular coagulation
• B Heparin-induced thrombocytopenia
• C Dilutional thrombocytopenia ✓
• D Thrombotic thrombocytopenic purpura

Explanation

Stored packed red blood cells lack functional platelets. Massive transfusion with predominantly red cell components dilutes the patient's own platelets, leading to dilutional thrombocytopenia. The platelet count typically falls below 50,000/µL after approximately 1.5 blood volumes. DIC would show elevated D-dimer, prolonged PT/PTT, and low fibrinogen. HIT requires heparin exposure and is associated with thrombosis. TTP presents with fever, renal failure, and neurologic changes. Platelet transfusion is indicated.

Reference: Schwartz's Principles of Surgery, 11th ed.

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