Images in Clinical Medicine
Disseminated Intravascular Coagulopathy
N Engl J Med 2001; 345:1394November 8, 2001
- Article
Figure 1 A 34-year-old man with the acquired immunodeficiency syndrome, hemoglobin SC chronic hemolytic anemia, and recurrent episodes of pneumonia due to gram-negative bacteria, cryptococcus, and most recently, aspergillus was treated with amphotericin B. Bilateral diffuse pneumonia, gram-negative septicemia with thrombocytopenia and refractory hypotension, and acute oliguric renal failure resulted in his admission to the hospital three days before he died.
Pseudomonas aeruginosa, Klebsiella pneumoniae, and aspergillus species were isolated from antemortem sputum cultures, and the first two organisms were also identified in antemortem blood cultures and postmortem lung cultures. The patient's peripheral-blood platelet count decreased from 228,000 to 9000 per cubic millimeter between his admission to the hospital and his death. On admission, the prothrombin time was 17 seconds (international normalized ratio, 1.8), and the activated partial-thromboplastin time was 36 seconds; additional coagulation studies were performed. The hematologic findings were consistent with the presence of hemoglobin SC chronic hemolytic anemia with occasional red-cell fragments; the latter were also present on smears obtained before the terminal illness.
Autopsy confirmed the presence of acute, bilateral, gram-negative pneumonia. The kidneys contained numerous platelet-fibrin thrombi, predominantly within glomerular capillaries (Panel A, hematoxylin and eosin, ×240; Panel B, Fraser–Lendrem stain, ×240), with smaller numbers of platelet-fibrin thrombi in the microcirculation of many organs. These findings were indicative of disseminated intravascular coagulopathy and corresponded to the clinical features of the terminal illness.
Sheldon Bastacky, M.D.
Robert E. Lee, M.D.
University of Pittsburgh Medical Center, Pittsburgh, PA 15213-2582
