Coagulation and fibrinolysis are usually finely balanced. Inappropriate activation of the coagulation cascade results in widespread fibrin deposition (clot formation), and coagulation factors and platelets are consumed faster than they can be replaced. Hence the paradox of both microvascular thrombosis and bleeding. The fibrin strands fragment passing red blood cells and the resulting microangiopathic haemolysis may be seen on the blood film.

The following laboratory changes are therefore seen in severe sepsis:

• reduced platelets

• reduced fibrinogen

• elevated d-dimer

• microangiopathic haemolysis leading to anaemia and reticulocytosis.

This picture is described as disseminated intravascular coagulation (DIC).

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