A 52-year-old man with a 10-year history of alcohol use disorder and biopsy-proven cirrhosis presents to the emergency department with hematemesis. Physical examination reveals jaundice, ascites, and spider angiomas. Vital signs: BP 98/62, HR 112, RR 22, temperature 37.2°C, SpO2 98% on room air. He denies recent aspirin or anticoagulant use. Laboratory studies show: PT: 18 seconds (normal 12-14) aPTT: 42 seconds (normal 25-35) Platelet count: 85,000/µL Fibrinogen: 120 mg/dL (normal 200-400) INR: 1.8 Total bilirubin: 4.2 mg/dL Albumin: 2.1 g/dL Which of the following best explains this patient's coagulation abnormalities?
- A)Selective deficiency of vitamin K-dependent factors due to cholestasis
- B)Thrombotic thrombocytopenic purpura with secondary coagulopathy
- C)Disseminated intravascular coagulation secondary to bacterial translocation
- D)Decreased hepatic synthesis of clotting factors and impaired fibrinogen productionGABARITO
- E)Heparin-induced thrombocytopenia with consumptive coagulopathy
Explicação
Cirrhosis causes multifactorial coagulation dysfunction due to impaired hepatic synthetic function. The liver synthesizes virtually all clotting factors (I, II, V, VII, VIII, IX, X, XI, XII) except VIII (which is also produced by endothelium). In cirrhosis, pr... Ver explicação completa e trilha adaptativa →