How does disseminated intravascular coagulation affect platelet and clot quality?

• A. Platelet consumption leads to thrombocytopenia; microangiopathic hemolysis can cause schistocytes; clots are disordered; global coagulopathy.
• B. Platelet production increases; clots become highly organized.
• C. Platelets unchanged; clot quality unchanged.
• D. Platelets decrease but no hemolysis; normal coagulopathy.

Answer: (A)

In disseminated intravascular coagulation, coagulation is activated throughout the circulation, leading to widespread formation of fibrin-rich microthrombi. This uses up platelets and clotting factors, so platelets become depleted, causing thrombocytopenia. The microthrombi in small vessels shear passing red cells, producing schistocytes and a form of microangiopathic hemolysis. Because clotting is occurring in many small vessels rather than forming a single, tightly controlled clot, the overall clot quality appears disordered. The ongoing consumption of coagulation components creates a global coagulopathy, so tests often show prolonged clotting times and other signs of bleeding tendency. This pattern—platelet consumption with hemolysis and widespread, disordered clots leading to a global coagulopathy—best matches the described option.