American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the platelet transfusion threshold for DIC patients?

1. 50K

2. 100K

3. 20K

4. 10K

The correct answer is: 100K

In patients with disseminated intravascular coagulation (DIC), the platelet transfusion threshold is typically set to 50,000 platelets per microliter. This threshold is based on the recognition that DIC often leads to thrombocytopenia due to the consumption of platelets, and maintaining a certain platelet count is crucial for preventing significant bleeding. The target of 50,000 is especially important in the context of DIC because these patients are at increased risk for bleeding complications, particularly if they are undergoing invasive procedures or if there are concerns about bleeding from other sources. Transfusing platelets above this threshold can help provide enough hemostatic function to reduce the risk of spontaneous bleeding. In contrast, lower thresholds like 20,000 or 10,000 might be applied in other clinical scenarios, such as in patients with isolated thrombocytopenia without the complex hemostatic derangements seen in DIC. However, in DIC, the clinical scenario is more dynamic and requires a careful approach to managing coagulopathy and ensuring adequate platelet levels. Thus, setting the transfusion threshold at 50,000 minimizes the risk while maximizing safety for patients experiencing this serious condition.