A 45-year-old woman on ICU following cardiac surgery has persistent mediastinal bleeding (200 mL/hr for 4 hours). Her coagulation results show: PT 14...

Question

A 45-year-old woman on ICU following cardiac surgery has persistent mediastinal bleeding (>200 mL/hr for 4 hours). Her coagulation results show: PT 14 seconds (control 12), APTT 38 seconds (control 28), fibrinogen 3.5 g/L, platelets 180 × 10⁹/L. TEG shows a normal reaction time (R) but a reduced maximum amplitude (MA) of 42 mm (normal >55 mm). What is the most likely cause of the reduced MA despite normal platelet count and fibrinogen?

Accepted Answer

Platelet dysfunction (e.g. from aspirin, clopidogrel, or cardiopulmonary bypass)

Answer

Fibrinolysis

Answer

Residual heparin effect

Answer

Factor XIII deficiency

Answer

Von Willebrand disease

uk-fficm MCQ (SBA): Post-Cardiac Surgery Bleeding