A 45-year-old man with cirrhosis presents with epistaxis and easy bruising. Vital signs: BP 128/76, HR 92, RR 16, Temp 37°C, SpO2 98%. He denies recent anticoagulant use. Laboratory studies reveal PT 18 seconds (normal 12-14), aPTT 45 seconds (normal 25-35), platelet count 75,000/µL, fibrinogen 120 mg/dL (normal 200-400), and albumin 2.8 g/dL. Which of the following best explains the primary cause of his coagulopathy?
- A)Heparin-induced thrombocytopenia
- B)Vitamin K deficiency alone
- C)Immune-mediated platelet destruction
- D)Disseminated intravascular coagulation
- E)Impaired hepatic synthesis of clotting factorsGABARITO
Explicação
Cirrhosis causes impaired hepatic synthesis of all clotting factors (factors II, V, VII, IX, X), resulting in prolonged PT and aPTT. Portal hypertension causes thrombocytopenia. Fibrinogen is also reduced due to decreased synthesis. Ver explicação completa e trilha adaptativa →