Differential Diagnosis for Elevated D-dimer in Cirrhosis Patient with Signs of Spontaneous Bruising
- Single most likely diagnosis
- Liver disease-associated coagulopathy: This is the most likely diagnosis given the patient's cirrhosis and signs of spontaneous bruising. Cirrhosis can lead to coagulopathy due to decreased production of coagulation factors by the liver, and an elevated D-dimer may indicate a state of hypercoagulability or consumption of clotting factors.
- Other Likely diagnoses
- Disseminated Intravascular Coagulation (DIC): This condition can occur in patients with cirrhosis and is characterized by both clotting and bleeding. An elevated D-dimer is a common finding in DIC.
- Portal Vein Thrombosis (PVT): PVT is a complication of cirrhosis and can cause an elevation in D-dimer levels. The thrombosis can lead to consumption of clotting factors, resulting in bruising.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hepatocellular Carcinoma (HCC) with tumor thrombosis: Although less common, HCC can cause an elevation in D-dimer levels, especially if there is tumor thrombosis. Missing this diagnosis could be fatal due to the aggressive nature of HCC.
- Infection or Sepsis: Infections can cause an elevation in D-dimer levels and are a common complication in cirrhotic patients. Sepsis can lead to DIC and multi-organ failure if not promptly treated.
- Rare diagnoses
- Antiphospholipid Syndrome (APS): This is an autoimmune disorder that can cause thrombosis and elevation in D-dimer levels. Although rare, it should be considered in patients with cirrhosis and unexplained thrombosis or coagulopathy.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): PNH is a rare disorder that can cause thrombosis, hemolysis, and elevation in D-dimer levels. It is an important diagnosis to consider in patients with unexplained coagulopathy and hemolysis.