A 26-year-old who recently underwent trauma with liver and spleen injuries develops oozing from surgical sites and a bloody urine, with thrombocytopenia and prolonged PT and fibrin split products. What is the most likely diagnosis?

• A. Acute ABO incompatibility reaction
• B. Disseminated intravascular coagulation
• C. Exacerbation of idiopathic thrombocytopenia
• D. Inadequate repair of the liver lacerations

Answer: (B)

Disseminated intravascular coagulation is a consumptive coagulopathy in which widespread activation of coagulation leads to microthrombi and rapid consumption of platelets and clotting factors. In severe trauma with liver and spleen injuries, tissue factor and other procoagulants are released into circulation, triggering systemic coagulation. This consumption of platelets and clotting factors produces oozing from surgical sites, hematuria, and lab results of thrombocytopenia with prolonged PT (and often prolonged aPTT) and elevated fibrin split products from ongoing fibrinolysis. These features together point to DIC as the most likely diagnosis. Transfusion reactions from ABO incompatibility would present differently and typically acutely after transfusion; idiopathic thrombocytopenia would cause low platelets with normal coagulation tests and no rise in fibrin degradation products; inadequate repair of liver injuries would not explain the widespread consumption coagulopathy seen here.