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Tutik Harjianti,SpPD,K-HOM
SubDiv.of Hematology & Medical Oncology Dept.of Internal Medicine, Medical Faculty Hasanuddin University
Sub Topics :
I. Introducton of D.I.C. II. Trigger Mechanism of D.I.C. III. Etiology of D.I.C. IV. Clinical pictures of D.I.C. V. Diagnosis of D.I.C. VI. Management of D.I.C. VII. Prognosis of D.I.C.
I. Introduction :
DIC
Disseminated : widespread Intravascular : inside the bloodline Coagulation : blood clot production __________________________________
Blood always in a liquid form Vascular disruption initiate coagulation ( as a part of normal hemostasis ) Coagulation is limited in area of lesion by the effect of : - blood streaming / blood flow - coagulation inhibitor inside the circulation (esp. Anti Thrombin III / AT III)
PHYSIOLOGY of COAGULATION
Vasculature rupture / lesion A Vasoconstriction B Primary hemostasis reaction C Coagulation D Fibrinolysis ( A,B,C & D = hemostasis mechanism)
Important Clue :
The presence of thrombin circulating in bloodline. __________________________________ Normally : thrombin can only be found in area of lesion (where the coagulation process is still running)
DIC
DIC
DIC
- Oftenly undiagnosed - Unexplained bleeding usually lead the clinician to think about D.I.C.
1. Abnormal coagulation 2. Bleeding (more often) - can be found at any place - spontaneous bleeding - at the site of wound, ooze, cath etc.
Thrombosis can be occurred if the abnormality of coagulation more prominent than fibrinolysis - digital ischaemia - gangrene (necrosis) - Necrosis of cortex of kidney - Adrenal gland necrosis & bleeding
Trousseau Syndrome
Subacute DIC Oftenly found in cancer patients Thrombosis in superficial & profundal veins (DVT), commonly recurrent
V. Diagnosis of D.I.C.
1. Clinical pictures (severe disease, bleeding, thrombosis) 2. Laboratory : fibrinogen < FDP > platelet < Prothrombin Time > actvated Partial Thromboplastin Time (aPTT) >
1. Liver Diseases (normal fibrinogen ) 2. Vit K defc (normal fibrinogen & platelet)
2. Cryoprecipitate transfusion
(maintain the fibrinogen > 150.000 mg/dL)
Management.
3. Fresh Frozen Plasma transfusion (to increase coagulation factors)
4. Heparin : still controversial Should be given with Replacement Tx Dose : 500 750 u / hour
TERIMA KASIH
Action of Plasmin :
Thrombin :
Fibrinogen conversion fibrin monomer Stimulation of platelet aggregation Activation of f V & f VIII Release of plasminogen activator plasmin formation.