Normal PT/INR w/DIC??

[oeue2007]

Is it possible for a pt w/ DIC to have a normal PT/INR? Pt was elderly, recent vascular surgery, died 10 minutes after he got to the floor of "upper GI bleed" per MD. He looked like coumadin toxicity but PT/INR was normal. Platelets in the basement, no d-dimer or fibrinogen labs done in ER. Just wondering. The ones you lose nag at you, ya know?

[core0]

Is it possible for a pt w/ DIC to have a normal PT/INR? Pt was elderly, recent vascular surgery, died 10 minutes after he got to the floor of "upper GI bleed" per MD. He looked like coumadin toxicity but PT/INR was normal. Platelets in the basement, no d-dimer or fibrinogen labs done in ER. Just wondering. The ones you lose nag at you, ya know?

Mild DIC can have a normal PT/PTT the only abnormality is usually in the fibrin degradation products. However, this is usually not associated with massive bleeding.

In this case I would consider HIT as a cause of the bleed (although there is a lot of disagreement on how long you need to be exposed to heparin for this to happen). There are also thrombolytics that are occasionally used in vascular surgery that leave the PT/PTT normal but dysfunctional. When you say Coumadin toxicity are you talking about purpura? In that case HIT would definitely be on the list.

David Carpenter, PA-C

[zacarias, ASN, RN]

How can you have a normal PT/PTT and yet them be dysfunctional? Or how do you mean?

Zach