A patient with cirrhosis of liver has the following coagulation parameters, Platelet count 2,00,000, Prothrombin time 25s/12s, Activated partial thromboplastin time 60s/35s, thrombin time 15s/15s. In this patient-
**Core Concept**
The patient's coagulation parameters are indicative of a complex coagulopathy associated with cirrhosis of the liver. This condition involves a multifactorial impairment of both the intrinsic and extrinsic coagulation pathways, leading to a paradoxical decrease in clotting factors and an increase in fibrinolysis.
**Why the Correct Answer is Right**
The patient's prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) suggest a deficiency in both the extrinsic (factors VII, X, V, II) and intrinsic (factors XII, XI, IX, VIII) coagulation pathways. The normal thrombin time (TT) indicates that the fibrinogen level and the fibrin polymerization process are intact. However, the thrombocytopenia (low platelet count) and decreased coagulation factor production in the liver contribute to the coagulopathy.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not provided, as the question format requires only four options.
**Option B:** This option is incorrect because it does not accurately describe the patient's coagulopathy. The patient's prolonged PT and aPTT are not consistent with a diagnosis of isolated thrombocytopenia.
**Option C:** This option is incorrect because it does not accurately describe the patient's coagulopathy. The patient's normal TT and the presence of thrombocytopenia make a diagnosis of disseminated intravascular coagulation (DIC) unlikely.
**Option D:** This option is incorrect because it does not accurately describe the patient's coagulopathy. The patient's prolonged PT and aPTT are not consistent with a diagnosis of factor XIII deficiency.
**Clinical Pearl / High-Yield Fact**
In patients with cirrhosis, the coagulopathy is often referred to as "cirrhotic coagulopathy" and is characterized by a deficiency in both the extrinsic and intrinsic coagulation pathways. This condition is a major risk factor for bleeding complications in these patients.
**Correct Answer:** B. The patient has a coagulopathy associated with cirrhosis, characterized by a deficiency in both the extrinsic and intrinsic coagulation pathways.