Figure 1. The most recent CT abdomen and pelvis performed prior to initial ED visit with bleeding. CT scan at this time demonstrated progression of disease with worsening pulmonary nodules, bilateral retroperitoneal adenopathy, soft tissue thickening around esophageal hiatus (arrow) (a), and new left adrenal lesion (arrow) (b). ED: emergency department; CT: computed tomography.
Figure 2. The trend of disseminated intravascular coagulation (DIC) labs from initial bleeding event until patient death, including platelet count, fibrinogen level, prothrombin time (PT), and partial thromboplastin time (PTT). PTT was not included due to simplicity. Additionally, PTT generally correlated with PT except when on enoxaparin and was higher due to enoxaparin once initiated.
Figure 3. The timeline of patient’s oncologic disease and progression with subsequent presentations to the hospital, highlighting the initiation and cessation of TKI inhibitors as well as anticoagulant therapies. GIST: gastrointestinal stromal tumor; DIC: disseminated intravascular coagulation; ED: emergency department; TKI: tyrosine kinase inhibitor.
Figure 4. Flowchart depicting the diagnosis and management of DIC based on bleeding or thromboembolic predominance [1, 18]. This flowchart was adapted from flowchart developed by Levi et al [1]. PT: prothrombin time; DIC: disseminated intravascular coagulation.