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The question
In the labour room of a district hospital at 2 a.m., a multigravida at 34 weeks with pre-eclampsia is delivered of a dead fetus after a concealed abruptio placentae with a large retroplacental clot. Despite oxytocin and a well-contracted uterus she keeps bleeding from the genital tract, the IV cannula sites and her gums, and the blood in a plain tube does not clot after 10 minutes. Results: platelets 60,000/µL, PT 24 s (control 13), aPTT 58 s (control 32), fibrinogen 80 mg/dL (normal 200-400), D-dimer markedly raised. The uterus has been emptied and red cells are being given. Which component best corrects the deficit that most threatens clot formation here?
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