The doctor The patient The hematologist
A-52-year-old woman treated with immunotherapy after a diagnosis of melanoma. Four months after the first treatment, the patient started with petechiae and ecchymosis widely distributed along her skin.
The Lab tests showed a low platelet level and an elevated D-dimer with almost a normal fibrinogen value.
I’m afraid about my body, I have a lot of red spot on my skin. I need a solution because I feel unwell every day.
I’m sure that there is a coagulation problem here, because the clinical picture and the low level of platelets and the D-dimer elevated. However, I don´t understand the normal fibrinogen level. I will prescribe Vitamin K and I will stop heparin.
Do you have any suggestion? Let’s ask to the hematologist
The clinical picture could be compatible with a disseminated intravascular coagulation. Did you measure the coagulative or functional fibrinogen? You know, the fibrinogen level can be almost normal because it is also an acute-phase reactant , but probably only a percentage it is useful to work for a proper coagulation function.
The functional or coagulative fibrinogen was clearly in a very low level. Fortunately, we will start the therapeutic administration of fibrinogen to improve the clinical situation.
There are in Medicine many details related to the physiopathology or the treatment of every specialty, that could be an opportunity to start a treatment that could save the life of a person.
. Semin Thromb Hemost 2020 Feb;46(1):38-49.
doi: 10.1055/s-0039-1696946. Epub 2019 Oct 1