**Question:** Streptokinase and urokinase are contraindicated in

A. Patients with bleeding disorders
B. Patients with known allergy to the drug
C. Patients with severe renal impairment
D. Patients with active intracranial haemorrhage

**Core Concept:**
Streptokinase and urokinase are thrombolytic agents that act as plasminogen activators, breaking down blood clots by converting plasminogen to plasmin. They are used to dissolve blood clots in various clinical settings. However, their use is limited by certain contraindications.

**Why the Correct Answer is Right:**
D. Patients with active intracranial haemorrhage are contraindicated to receive streptokinase and urokinase due to their potential to cause further bleeding and exacerbate the intracranial bleed. Streptokinase and urokinase increase the activity of plasmin in the blood, which can lead to increased bleeding risk, especially in patients with pre-existing bleeding disorders or active bleeding.

**Why Each Wrong Option is Incorrect:**
A. Controlling bleeding disorders is not a direct contraindication for thrombolytic agents. Thrombolytic agents primarily act to dissolve blood clots, not manage bleeding disorders. However, patients with impaired bleeding tendencies must be carefully assessed before thrombolytic therapy to ensure that the benefits outweigh the risks.

B. Allergy to the drug is not a direct contraindication for thrombolytic agents. While hypersensitivity reactions can occur, they are relatively uncommon. In most cases, the benefit of dissolving the clot outweighs the risk of an allergic reaction. However, patients with a known severe hypersensitivity to these drugs should be cautious when considering thrombolytic therapy.

C. Severe renal impairment is a relative contraindication for thrombolytic therapy. While thrombolytic agents can still be used, patients with severe renal impairment require closer monitoring and may require dose adjustments. In severe cases, alternative treatments should be considered. However, in moderate renal impairment, thrombolytic therapy can still be used, and patients should be closely monitored for potential side effects.

**Clinical Pearl:**
In clinical practice, it is essential to carefully evaluate patients' medical history and coagulation status before administering thrombolytic agents. Although thrombolytic agents are critical for dissolving blood clots, they must be used judiciously in patients with bleeding disorders, severe renal impairment, or known allergies to the drugs.

**Correct Answer:** D. Active intracranial haemorrhage.