SBA — Single Best Answer · Review
Question 186
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman with severe placental abruption has received red cells and fresh frozen plasma during continuing massive haemorrhage. Repeat tests show Hb 88 g/L, platelets 104 × 10⁹/L, fibrinogen 0.6 g/L and improving PT/APTT. Diffuse bleeding persists. Which result most specifically identifies an inadequately corrected haemostatic deficit requiring targeted component replacement?
Question Stem
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Options
A
Haemoglobin 88 g/L
B
Platelet count 104 × 10⁹/L
C
Improving PT/APTT
D
Fibrinogen 0.6 g/L
E
Continuing vaginal bleeding alone
Explanation
The key residual abnormality is profound hypofibrinogenaemia. Although red-cell requirements must continue to be assessed according to blood loss and physiology, and coagulation tests require serial monitoring, a fibrinogen concentration of 0.6 g/L represents severe depletion requiring targeted fibrinogen replacement, typically with cryoprecipitate in the context of massive haemorrhage. The platelet count is not the dominant abnormality presented. This requires selecting the haemostatic defect that remains inadequately corrected despite plasma therapy rather than simply responding to the lowest-looking number.
Option Validity
A) The haemoglobin may require ongoing management, but it does not identify the specific haemostatic substrate deficiency causing persistent coagulopathic bleeding.
B) The platelet count is not the most severe residual haemostatic abnormality in this scenario.
C) Improving clotting times do not correct or negate profound fibrinogen depletion.
E) Continued bleeding mandates reassessment, but the question asks which laboratory result identifies the specific targeted deficit.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.