25 August 2011 (Thursday) - Coagulation on ITU

I got my arse kicked at work today. I’d made a mistake on a coagulation investigation I’d performed two days ago:

POTTS ,CARACTACUS                  DOB  06/03/1959 Sex M Pat No 739185       Source    ITU Address   in a windmill  Specimen No : AW182862N    (Haematology)          23/08/2011 u/k  Citrated Blood  Request Reason :     RTA, pneumonia   PT         20.3           s            (    12 to 16    ) Auth   APTT       30.5           s            (    22 to 35    ) Auth   APTT Ratio ^1.0                                           Auth

Apparently I should have added a thrombin time and a fibrinogen because….. pneumonia can (occasionally) cause D.I.C.

Personally I would have thought that the result of a fibrinogen assay (and consequently a thrombin time) on an ITU patient could be absolutely bloody anything because of the nature of ITU patients.

Fibrinogen may well be high because of the acute phase reactions, or my be low due to massive bleeds or liver disease (both common in ITU patients)

I must be missing something here….