Differential Diagnosis

• Single most likely diagnosis
  • Disseminated intravascular coagulation (DIC): This condition is characterized by both widespread clotting and bleeding in critically ill patients, making it the most likely diagnosis. DIC occurs when the coagulation system is activated, leading to the formation of numerous small clots in small blood vessels throughout the body, which can consume clotting factors and platelets, resulting in a bleeding tendency.
• Other Likely diagnoses
  • Hemolytic uremic syndrome (HUS): While primarily known for its association with renal failure and microangiopathic hemolytic anemia, HUS can also involve some degree of clotting and bleeding, although it is less commonly associated with a disorder of both clot formation and bleeding compared to DIC.
• Do Not Miss
  • Drug-induced thrombocytopenia: Although less likely to present with both clot formation and bleeding, certain drugs can induce antibodies that destroy platelets, leading to thrombocytopenia. In rare cases, this could be associated with paradoxical clotting due to the removal of platelets that are necessary for normal clot regulation.
  • Immune thrombocytopenic purpura (ITP): Similar to drug-induced thrombocytopenia, ITP is primarily a disorder of bleeding due to low platelet counts. However, in rare instances, especially if there is significant inflammation or other complicating factors, ITP could theoretically contribute to a complex coagulopathy.
• Rare diagnoses
  • Thrombotic thrombocytopenic purpura (TTP): While TTP is characterized by thrombocytopenia, microangiopathic hemolytic anemia, renal failure, neurological symptoms, and fever, it is less commonly considered in the differential for a disorder of both clot formation and bleeding in critically ill patients compared to DIC or HUS. However, it does involve clot formation and could be considered in rare cases.