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Department of Pathology
Case of the Month January 2003
THE BIG THAW
Matrina Schmidt, MD, Linda Cook, MD and Patricia Canfield, MD
TABLE 1 Admitting Laboratory Results
Laboratory Tests |
Results |
Reference values |
| WBC |
17.9 THOU/uL |
3.5-11 Thou/uL |
| Hgb |
14.8 g/dL |
13.1 – 17.3 g/dL |
| HCT |
44.6 % |
39.8 – 50.2% |
| PLT |
292,000 THO/uL |
140 – 450 Thou/uL |
| PT |
17.3 sec |
135 – 148 mmol/L |
| INR |
------- |
3.5 – 5.1 mmol/L |
| PTT |
29.3 sec |
24.8 – 37.3 seconds |
| Fibrinogen |
312 mg/dL |
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The patient was admitted to the Neurosurgical Service and 12 units of Fresh Frozen Plasma (FFP) was ordered. The patient responded to the initial FFP with a correction of his PT. However, within a short time, the PT became prolonged and more FFP was ordered and administered. This scenario continued until a total of 32 units of FFP were administered. The patient expired (See Table 2).
TABLE 2
No Vitamin K |
PT (sec) |
PTT (sec) |
Action |
| Day 1 (admission) |
17.3 |
29.3 |
5 units FFP |
| Day 2 00:38 |
----- |
----- |
1 unit FFP |
| Day 2 02:00 |
----- |
----- |
6 units FFP |
| Day 2 03:00 |
12.0 |
29.2 |
--------- |
| Day 2 09:00 |
12.8 |
29.0 |
--------- |
| Day 2 15:00 |
13.8 |
29.3 |
4 units FFP (19:55) |
| Day 2 23:26 |
13.5 |
28.5 |
--------- |
| Day 3 01:05 |
----- |
----- |
4 units FFP |
| Day 3 04:41 |
11.9 |
28.3 |
--------- |
| Day 3 09:00 |
12.9 |
28.5 |
--------- |
| Day 3 15:00 |
14.9 |
26.7 |
2 units FFP (16:35) |
| Day 3 20:56 |
15.1 |
29.5 |
2 units FFP (21:43) |
| Day 4 04:37 |
15.1 |
28.0 |
--------- |
| Day 4 08:40 |
15.9 |
27.8 |
6 units FFP (09:19) |
| Day 4 15:00 |
14.1 |
29.6 |
2 units FFP (17:17) |
| Day 4 21:00 |
14.9 |
28.4 |
--------- |
| Day 5 00:37 |
----- |
----- |
4 units FFP |
| Day 5 04:55 |
13.9 |
29.2 |
6 units FFP (07:41) |
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