04 June 2026
: Case report 
Acute Intraoperative Disseminated Intravascular Coagulation During Suppurative Keloid Excision: A Case Report
Unusual clinical course, Diagnostic / therapeutic accidents
Bang Luong Nguyen ABCDEF 1, Minh Quang Pham ADEF 1,2, Tu Huu Nguyen ADEF 1,2, Nhung Thi Cuc Nguyen ADEF 3, Khoa Xuan Ngo ADEF 4,5, Mat Thi Nguyen ADEF 5, Anh Quang Pham ABCDEF 5, Trung Thai Vo ADEF 5, Hong Van Hoang ABCDEF 5*DOI: 10.12659/AJCR.951241
Am J Case Rep 2026; 27:e951241
Table 2 Key distinguishing features between DIC and other coagulopathies.
| Feature | Overt DIC (ISTH) | Dilutional coagulopathy | SAC | Liver-related coagulopathy | Our patient |
|---|---|---|---|---|---|
| Typical triggers | Infection, trauma, malignancy; systemic inflammation with coagulation activation | Massive crystalloid/colloid resuscitation or PRBC transfusion without balanced plasma/platelet/fibrinogen replacement | Sepsis; may precede or progress to overt DIC | Acute or chronic liver failure; portal hypertension, hypersplenism | Chronically inflamed suppurative keloid + extensive surgical trauma; high PCT (>100 ng/mL) |
| Platelet count | Often below 100 G/L due to consumption | Mild to moderate decrease from dilution; improves with platelet transfusion and hemostasis | Often normal or slightly reduced early; may decrease with progression | Reduced in hypersplenism or advanced disease | 61 G/L |
| Fibrinogen | Low (< 1.0 g/L) in bleeding-phase DIC (consumption ± hyperfibrinolysis) | Low from dilution; promptly increases with cryoprecipitate or fibrinogen concentrate | Normal or elevated initially (acute-phase reactant), may decrease later | Low in severe liver failure; dysfibrinogenemia possible | 0.5 g/L |
| PT-INR | Prolonged (often >1.5) | Mild to moderate prolongation; improves with FFP | Mild prolongation common | Prolonged at baseline; may be greatly prolonged in liver failure | INR 6.25 (peak) |
| aPTT | Prolonged | Mild to moderate prolongation | Variable | Prolonged | 96 seconds |
| D-dimer/fibrinolysis | Substantially elevated D-dimer; hyperfibrinolysis common in bleeding phenotype | Normal or mildly elevated | Elevated but often less extreme than in overt DIC | Mild to moderate elevation possible | >20 000 ng/mL |
| Intraoperative bleeding pattern | Diffuse oozing from raw surfaces or needle holes; difficult hemostasis | Bleeding localized to surgical field; improves with balanced transfusion | Oozing may occur; risk of microvascular bleeding with progression | Variable; rebalanced hemostasis may mask bleeding tendency | Diffuse intraoperative oozing and early postoperative bleeding |
| ROTEM/TEG (typical) | Prolonged CT/CFT, low MCF; evidence of hyperfibrinolysis (eg, rapid clot lysis) | Low FIBTEM amplitude; improves after fibrinogen replacement | Variable; may become hypocoagulable with progression | “Rebalanced” profile; thrombin generation may be near normal | Not available (acknowledged limitation) |
| Preoperative coagulation | May be normal prior to trigger, then acutely deranged | Normal preoperatively | May show mild PT prolongation or platelet changes | Chronically abnormal PT-INR ± thrombocytopenia | Normal preoperatively |
| Response to targeted therapy | Treat underlying trigger + component therapy (FFP, cryoprecipitate, platelets) ± TXA in hyperfibrinolysis; gradual correction | Rapid correction with balanced transfusion (PRBC: FFP: platelets) and fibrinogen | Treat sepsis; avoid unnecessary procoagulants; may progress to DIC | Variable response to plasma; bleeding often multifactorial | PRBC 9 U, FFP 9 U, cryoprecipitate 10 U, platelets 1 U + TXA; normalization by ~14 h |
| Overall impression | Consumptive coagulopathy with pronounced fibrinolysis in bleeding phenotype | Hemodilution of factors and platelets without systemic consumption | Sepsis-driven dysregulation; may progress to overt DIC | Chronic synthetic dysfunction with “rebalanced” hemostasis | Findings align with overt DIC rather than dilutional, SAC, or liver-related etiologies |
| aPTT – activated partial thromboplastin time; CFT – clot formation time; CT – clotting time; DIC – disseminated intravascular coagulation; FFP – fresh frozen plasma; FIBTEM – fibrin-based thromboelastometry; ISTH – International Society on Thrombosis and Haemostasis; MCF – maximum clot firmness; PRBCs – packed red blood cells; PT-INR – prothrombin time-international normalized ratio; ROTEM/TEG – rotational thromboelastometry/thromboelastography; SAC – sepsis-associated coagulopathy; TXA – tranexamic acid. | |||||