DISSEMINATED INTRAVASCULAR COAGULATION

(DIC) IN OBSTETRIC PRACTICE

Abstract:
Disseminate intra!asc"#ar c$a%"#ati$n (DIC) is an ac&"ire an c$m'#e( is$rer t)at $cc"rs
in a *ie !ariet+ $, c#inica# c$niti$ns- T)is is basica##+ a state $, increase 'r$'ensit+ ,$r c#$t
,$rmati$n tri%%ere b+ a !ariet+ $, stim"#i re#ate t$ s"c) i!erse is$rers as se'sis. en$t)e#ia#
ce## ama%e ()eat str$/e. s)$c/). $bstetrica# c$m'#icati$n (abr"'ti$ '#acenta. amni$tic ,#"i
emb$#ism. se!ere 'reec#am'sia an retaine intra"terine ea ,$et"s) an ne$'#asm- DIC is a
c#assic c$m'#icati$n $, $bstetric c$niti$ns $cc"rrin% in m$re t)an 01 'ercent $, 'atients *it)
$bstetric ca"ses- In DIC. an "nre%"#ate t)r$mbin e('#$si$n ca"se re#ease $, ,ree t)r$mbin
int$ t)e circ"#ati$n t)at #eas t$ t)e c#inica# ,eat"res $, DIC. *it) t)r$mbin an '#asmin
res'$nsib#e ,$r t)e t)r$mb$tic an )aem$rr)a%ic mani,estati$ns. res'ecti!e#+- T)e ia%n$sis
an treatment $, t)is s+nr$me re&"ire an "nerstanin% $, its 'at)$')+si$#$%+. a*areness $,
t)e is$rers t)at can tri%%er it an its ear#+ rec$%niti$n- Ac"te DIC is "s"a##+ ass$ciate *it)
in,ecti$ns. t)e c$mm$nest ca"se. ab$"t 213415 $, 'atients *it) %ram ne%ati!e se'sis )a!e
e!ience $, DIC- C)r$nic DIC is "s"a##+ ass$ciate *it) retaine ea ,et"s. carcin$mat$sis-
T)e ia%n$sis $, t)is s+nr$me is essentia##+ c#inica#. *it) #ab$rat$r+ tests 'r$!iin% c$n,irmat$r+
e!ience- Micr$!asc"#ar t)r$mb$sis is t)e 'rimar+ mec)anism in m$st cases. an en $r%an
,ai#"re is a ma6$r ca"se $, eat)- N$ sin%#e ia%n$stic test e(ists ,$r DIC- DIC is initia##+
s"%%este b+ t)e ,$##$*in% c$mbinati$n7 a c#inica# c$niti$n c$nsistent *it) DIC.
t)r$mb$c+t$'enia. 'r$#$n%e PT. APTT. an 'resence $, 8DP9D3imer- Meica# treatment
e'ens $n t)e ca"se $, t)e DIC- Basica##+ it in!$#!es rem$!in% t)e ca"se ,$r e(am'#e. e#i!er+
$, '#acenta i, it is retaine $r abr"'te. e#i!er+ $, ,$et"s i, retaine. &"ic/ e#i!er+ i, se!ere
ec#am'sia an s$ $n. )+sterect$m+ i, b#eein% can n$t be c$ntr$##e ,r$m '#acenta# site- A,ter
t)en. an9$r c$n3c"rrent#+ treat DIC *it) b#$$ an '#asma trans,"si$ns an a''r$'riate
s"''$rti!e meas"res- As t)e se&"e# $, DIC can be e!astatin%. ear#+ c#inica# s"s'ici$n an
#ab$rat$r+ ia%n$sis are essentia#- T)is re!ie* artic#e 'r$!ies essentia# %"ie#ine ,$r t)e
a''r$'riate ia%n$sis an c#inica# mana%ement $, DIC in $bstetric 'atients-
:e+ *$rs: Disseminate intra!asc"#ar c$a%"#ati$n (DIC). Obstetric. T)r$mb$sis. 8ibrin. Dimer.
8DP. Antic$a%"#ant-
Intr$"cti$n:
Disseminate intra!asc"#ar c$a%"#ati$n is a c#inica# s+nr$me c)aracteri;e b+ s+stemic
acti!ati$n $, c$a%"#ati$n cascae sim"#tane$"s#+ #eas t$ intra!asc"#ar t)r$mb"s
,$rmati$n (c$m'r$misin% b#$$ s"''#+ t$ !ari$"s $r%ans ) an e()a"sti$n $, '#ate#ets an
c$a%"#ati$n ,act$rs (res"#tin% in )em$rr)a%e)- DIC is "nc$mm$n b"t n$t rare- T)e incience
$, t)e s+nr$me !aries in ass$ciati$n *it) i,,erent is$rers- In $bstetrica# c$niti$ns.
s"c) as abr"'ti$ '#acenta an amni$tic ,#"i emb$#ism. DIC $cc"rrin% in m$re t)an 015 $,
cases- In se!ere 'reec#am'sia DIC $cc"rre in <5 $, 'atients. in $ne st"+- Disseminate
intra!asc"#ar c$a%"#ati$n ma+ be c#assi,ie acc$rin% t$ its ac"teness an c#inica# se!erit+7
i) Ac"te DIC. ii) S"b3ac"te DIC $r C)r$nic DIC- Obstetrica# ca"ses $, DIC can be c#assi,ie as
ac"te an c)r$nic- DIC ma+ be t)e res"#t $, sin%#e $r m"#ti'#e c$niti$ns- Ac"te DIC in
'#acenta# abr"'ti$n. amni$tic ,#"i emb$#ism. se!ere 'reec#am'sia $r ec#am'sia. Obstetric
se'sis. Se'tic ab$rti$n $r sa#ine ab$rti$n. ac"te ,att+ #i!er $, 're%nanc+. e(tensi!e
s"r%ica# tra"ma. massi!e b#$$ trans,"si$n- s"b3ac"te $r c)r$nic DIC in retaine ea ,et"s
s+nr$me. retaine 'r$"cts $, c$nce'ti$n. e%eneratin% )+atii,$rm m$#es. ab$mina#
(ect$'ic) 're%nanc+. sa#ine in"ce ab$rti$n. ,et$matarna# b#$$ 'assa%e. '$st'art"m
)aem$#+tic "reamic s+nr$m metastatic carcin$ma (e-%7 $!ar+)- =emat$#$%ica# c)an%es
"rin% 're%nanc+ are critica#- N$rma# 're%nanc+ is ass$ciate *it) a ran%e $,
a#terati$ns t$ )aem$static c$m'$nent. *)ic) c$mbine t$ %i!e an increase ris/ $,
)em$rr)a%e. t)r$mb$sis an DIC- Pre%nanc+ is ass$ciate *it) a 4134115 increase in #e!e#
$, ,ibrin$%en an ,act$rs II.VII. >. VIII an >II. *)ere as c$ncentrati$ns $, ,act$rs V an I> are
"nc)an%e- T)"s net e,,ect $, 're%nanc+ ass$ciate c)an%es in )aem$static an
,ibrin$#+tic 'r$teins en)ances t)e ris/ $, t)r$mb$emb$#ism- T)e n$rma# ran%e ,$r t)e
'#ate#et c$"nt (2013 ?11 (21@9L) $es n$t a#ter "rin% 're%nanc+-
The pathogenesis of DIC is complex:
T)e mec)anisms t)at tri%%er DIC act $n 'r$cesses $, '#ate#et a)esi$n an a%%re%ati$n
an c$ntact acti!ate (intrinsic) an tiss"e ,act$r acti!ate (e(trinsic) 'at)*a+ $,
c$a%"#ati$n- T)e n$rma# c$m'ensat$r+ 'r$cess ma+ bec$me im'aire. creatin% a se#,
'er'et"atin% A!ici$"s c+c#eB- T)e "#timate $"tc$me is etermine b+ a +namic inter'#a+
bet*een t)e !ari$"s 'at)$#$%ic 'r$cesses an c$m'ensat$r+ mec)anisms in $t)er *$rs
,ibrin e'$siti$n !ers"s ,ibrin$#+sis7 e'#eti$n !ers"s re'#eti$n $, c$a%"#ati$n $, ,act$rs an
'#ate#ets7 an 'r$"cti$n !ers"s c#earance $, ,ibrin. 8DP an $t)er 'r$"cts $, c$a%"#ati$n-
In m$st ,$rms $, DIC. t)e initiatin% ,act$rs are m"#ti'#e an interre#ate- Ac"te DIC $n#+
res"#ts *)en t)e n$rma# c$m'ensat$r+ mec)anisms $, )aem$stasis )a!e been
$!erc$me- Direct '#ate#et acti!ati$n in se'ticemia an !iraemic states7 '#ate#et
acti!ati$n *i## a#s$ res"#t ,r$m !esse# *a## en$t)e#ia# ama%e an ,$##$*in% t)r$mbin
%enerati$n b+ t)e c$a%"#ati$n cascae- A c$mbinati$n $, c$a%"#ati$n ,act$r e,icienc+.
t)r$mb$c+t$'enia. im'aire '#ate#et ,"ncti$n. an in)ibit$r+ acti$n $, raise 8DPS. ca"ses
t)e %enera#i;e an c$ntin"in% *ies'rea b#eein% tenenc+- C)r$nic $r Ac$m'ensateB
DIC res"#t ,r$m a *ea/ $r intermittent acti!atin% stim"#"s- In s"c) 'atients. estr"cti$n an 'r$"cti$n $,
c$a%"#ati$n ,act$rs an '#ate#ets are ba#ance- T)e 'at)$')+si$#$%+ $, s"c) c)r$nic. s"b3ac"te $r
Ac$m'ensateB DIC is ,"namenta##+ t)e same as t)at in t)e ac"te case- Ne!ert)e#ess. t)e
istincti$n is !a#"ab#e beca"se t)e c#inica# 'ict"re an #ab$rat$r+ ,inin%s in t)e c)r$nic
,$rm are &"ite !ariab#e an ma+ be ia%n$stica##+ c$n,"sin%- C)r$nic DIC )as been
escribe in m$st 'atients *it) intra"terine ,$eta# eat) - Ot)er eti$#$%ic ,act$rs t)at ma+
'r$"ce c)r$nic DIC inc#"e !ari$"s ,$rms $, !asc"#itis. )+atii,$rm m$#es. an
e%eneratin% #ei$m+$mas- C)r$nic DIC )as man+ c#inica# an #ab$rat$r+ ,eat"res t)at
resemb#e an intermeiate sta%e bet*een t)e A)+'erc$a%"#ab#e stateB an ac"te DIC- Inee.
e!en n$rma# 're%nanc+ )as been s"%%este as a ,$rm $, #$* %rae A')+si$#$%icB DIC *)ic) at
term bec$mes $!ert ,$r a s)$rt time-
T)e e('$s"re $, 'r$c$a%"#ent tiss"e e(tracts t$ b#$$ is a ma6$r c$ntrib"t$r+ ,act$r in m$st
,$rms $, DIC an is $, ma6$r 'at)$%enetic im'$rtance in cases ass$ciate *it) abr"'ti$n
'#acenta. intra"terine ,eta# eat). ac"te 'r$m+e#$c+tic #e"/aemia. amni$tic ,#"i
emb$#ism. massi!e tra"ma. an !ari$"s ne$'#asms-
Abruptio placentae: In ab$"t 21 'ercent $, 'atients *it) abr"'ti$ '#acentae. an $!ert
c$a%"#$'at)+ e!e#$'s "e t$ DIC an ,ibnin$#+sis- De%ree $, '#acenta# se'arat$n
c$rre#ates *it) t)e se!erit+ $, DIC- DIC ma+ $cc"r in '#acenta# abr"'ti$n in!$#!in% #iberati$n
$, tiss"e t)r$mb$'#astin $r '$ssib#e intra"terine c$ns"m'ti$n $, ,ibrin$%en an
c$a%"#ati$n ,act$rs "rin% t)e ,$rmati$n $, retr$3 '#acenta# c#$t- T)is #eas t$ acti!ati$n $,
t)e e(trinsic c$a%"#ati$n mec)anism-
Amniotic fluid embolism: =ere is s$me "ncertaint+ ab$"t *)at e#ements in t)e amni$tic ,#"i are
res'$nsib#e ,$r t)e s+nr$me an *)et)er 'ri$r e('$s"re an sensiti;ati$n t$ amni$tic ,#"i are
necessar+- Ce##"#ar e#ements an $t)er ebris. s"c) as #an"%$ )air an !erni(. ma+ be im'$rtant- M"cin
,r$m mec$ni"m in t)e amni$tic ,#"i ca"ses a 'artic"#ar#+ intense reacti$n in t)e '"#m$nar+
arteri$#es- T)e mani,estati$n $, amni$tic ,#"i emb$#ism $es n$t a''ear t$ t)e e'enent
$n t)e &"antit+ $, amni$tic ,#"i t)at enters t)e materna# circ"#ati$n $r reac)es t)e '"#m$nar+ circ"#ati$n
an t)ere,$re it is be#ie!e t$ be an ana')+#actic res'$nse *)ic) is 'atient e'enent- T)e
'at)$')+si$#$%+ $, amni$tic ,#"i emb$#ism is a bi')asic res'$nse: t)e initia# ')ase $cc"rs a,ter t)e
amni$tic ,#"i
enters t)e '"#m$nar+ circ"#ati$n res"#tin% in !as$c$nstricti$n an '"#m$nar+ )+'ertensi$n7
sec$n ')ase is t)e sta%e $, )em$+namic c$m'r$mise c)aracteri;e b+ $eema an ri%)t sie )eart
,ai#"re- Amni$tic ,#"i c$ntains )i%) c$ncentrati$ns $, '#asmin$%en 'r$acti!at$rs. b"t it #ac/s
'#asmin$%en acti!at$r-
Intrauterine foetal death: Retenti$n $, a ea ,$et"s can 'reci'itate abn$rma# materna# b#eein%- Un#ess
t)e ea ,$et"s is retain ,$r t)ree *ee/s $r #$n%er. c#inica##+ e!ient c$a%"#ati$n is$rers are rare- T)e
DIC ass$ciate *it) t)e ,$eta# eat) is a c)r$nic 'r$cess. an t)e 'atient ma+ 'resent in eit)er a
c$m'ensate $r a ec$m'ensate state- In intra"terine ,$eta# eat) tiss"e t)r$mb$'#astic s"bstances ,r$m
t)e ea ,$et"s are s#$*#+ b"t c$ntin"$"s#+ abs$rbe. 'r$"cin% a 'ict"re $, c)r$nic. b"t 'r$%ressi!e
DIC-
Preeclampsia & Eclampsia: T)e e(act eti$#$%+ an mec)anism remain "n/n$*n- T)is c$niti$n is
ass$ciate *it) c)r$nic c$a%"#ati$n abn$rma#ities t)at ma+ #ea t$ t)r$mb$c+t$'enia an e#e!ati$n $,
,ibrin e%raati$n 'r$"cts- T)e c$a%"#ati$n abn$rma#ities re,#ect '#ate#et a)erence t$ e('$se c$##a%en
at t)e sites $, ama%e en$t)e#ia- It is re#ate t$. b"t c#ear#+ istinct ,r$m DIC- Preec#am'sia an
ec#am'sia are "n/n$*n an "nc#ear 'rec"rs$rs t$ DIC- In 'reec#am'sia an ec#am'sia. 'atients )a!e
)i%)er am$"nts $, 8DPs in t)e b#$$ an "rine t)an $t)ers- T)e t)r$mb$c+t$'enia seen in 'reec#am'sia
an ec#am'sia is "e t$ t)e increase c$ns"m'ti$n $, '#ate#ets-
Saline or septic abortion: Sa#ine in"ce ab$rti$n )as been ass$ciate *it) s"bc#inica# DIC- Se!ere
cases $, DIC )a!e $cc"rre in 2:?1132:2111 cases- Disease ma+ be re#ate t$ t)e re#ease $, tiss"e
t)r$mb$'#astin ,r$m t)e '#acenta- Se'tic ab$rti$n ma+ a#s$ ca"se re#ease $, tiss"e t)r$mb$'#astin $r
re#ease $, bacteria# en$t$(in (')$s')$#i'is)- T)e c$mm$n in,ecti$ns in $bstetric 'ractice are se'tic
ab$rti$n an c)$ri$amni$nitis in 'remat"re r"'t"re $, t)e membranes- Gramne%ati!e bacteria are
res'$nsib#e ,$r se'tic s)$c/ in m$re t)an @0 'ercent $, a,,ecte 'atients-
Massie trauma: In massi!e tra"ma . ma6$r s"r%ica# 'r$ce"res s"c) as #acerate in6"ries $, cer!i(
"rin% e#i!er+. ama%e tiss"e e('ressin% tiss"e ,act$r acti!it+ 'res"mab#+ is a ma6$r initiatin% ,act$r-
Infections: DIC $,ten acc$m'anies se'ticemia (main#+ "e t$ Gram3ne%ati!e) as a res"#t $, se'tic
ab$rti$n. bacteria t)at '$ssess '$tent en$t$(ins-
Shoc!: It )as been s"%%este t)at DIC in!$#!e in a## ,$rms $, s)$c/ an t)at it is t)e centra# ,eat"re in
irre!ersib#e $r re,ract$r+ ,$rms-
Clinical presentation:
The major clinical features of DIC are bleeding, often of serious magnitude and abrupt onset, a
variable element of shock that is often out of proportion to apparent blood loss, and symptoms
of hypoperfusion of various vascular beds. Acute renal failure is common, and thromboembolic
manifestations often are
noted. Evidence of major organ dysfunction is a common finding in patients ith acute DIC,
most often including signs, symptoms, and laboratory evidence of abnormal pulmonary, renal,
hepatic, and central nervous system function. !ajor clinical problem and presenting feature of
acute DIC is bleeding, hich can vary from mild to severe form, manifesting as generali"ed
bruising, ecchimosis, petechiae,
especially over dependent areas and pressure sites and or bleeding from previously intact
venipuncture sites or around indelling intravenous needles. In patients ho develop DIC after
surgical procedures, alarming haemorrhage may develop around drains and accumulation of
blood may be concealed in
serous cavities. In #bstetric cases, post partum bleeding from the vagina may be particularly
severe. $evere haemorrhage and hypovolaemic shock can occur e%tremely rapidly in
pregnancy, hen it is usually related to labour. In subacute or chronic DIC, there is slo
activation of the haemostatic system, ith spontaneous bruising rather than major clinical
bleeding episodes. $uch as intrauterine foetal death may produce as slo progressive form of
DIC, in hich bleeding is a relatively late manifestation, often fore shadoed by deteriorating
renal function.
Laboratory Diagnosis:
In acute DIC, it is essential to demonstrate the abnormal laboratory parameters accurately and
&uickly, so that appropriate therapy can be instigated. The main haemostatic abnormalities are
reflected by a prolonged thrombin time, hypofibrinogenaemia and thrombocytopenia. A
fibrinogen level belo '((
%'()*+, and a thrombin time of more than double the control value are regarded as virtually
diagnostic, especially if associated ith a generali"ed bleeding state.
"aborator# inestigations
$A% &asic blood Examination: E(aminati$n $, t)e b#$$ smear re!ea#s sc)ist$c+t$sis in a''r$(imate#+
015 $, cases - M$re s"bt#e e!ience $, intra!asc"#ar )aem$#+sis $,ten is ,$"n. s"c) as increase ser"m
#e!e# $, #actic aci e)+r$%enase (LD=) an iminis)e )e't$%#$bin #e!e#s- T)r$mb$c+t$'enia is an
ear#+ an c$nsistent si%n $, ac"te DIC P#ate#et c$"nts in t)e ran%e $, 01 t$ 211>21@9L are "s"a# ,inin%s
b"t t)r$mb$c+t$'enia ma+ be se!ere-
$&% Coagulation defect: T)e Acti!ate 'artia# t)r$mb$'#astin time (APTT). Pr$t)r$mbin time (PT).
T)r$mbin time (TT) are 'r$#$n%e in m$st 'atients *it) ac"te DIC- Ear#+ in t)e c$"rse $, t)e is$rer
an in c)r$nic DIC. t)e APTT ma+ be n$rma# $r e!en s)$rter t)an n$rma#- T)e '#asma #e!e#s $,
,ibrin$%en an $, ,act$r V an >III "s"a##+ are si%ni,icant#+ e'resse7 ,ibrin$%en an ,act$r V are t)e
m$st c$nsistent#+ a,,ecte- In man+ 'atients 'artic"#ar#+ t)$se *it) abr"'ti$ '#acentae. n$rma#
'r$t)r$mbin #e!e#s are maintaine b"t mar/e )+'$'r$t)r$mbinaemia $,ten is 'resent in t)$se *it)
se'sis- In 'atients *it) c)r$nic DIC. 'r$t)r$mbin e,icienc+ is "n"s"a#. *)ere as si%ni,icant e,iciencies
$, ,act$r > are $,ten n$te-
$C% Tests for fibrinol#sis: 8ibrin$#+tic acti!it+ ca"ses raise #e!e# $, circ"#atin% ,ibrin c$m'#e(es an
8DPs- Le!e#s ab$!e 211C%9m# are "s"a##+ ,$"n in ac"te DIC (n$rma# ran%e D21C%9m#) 2E- Imm"n$#$%ica#
assa+s base $n m$n$c#$na# antib$ies t$ D3imer are m$re s'eci,ic t)an a %enera# screen- Since ,a#se
'$siti!e res"#ts ma+ be seen *it) 8DPs- 8DPs test is n$t ia%n$stic $, DIC. +et #e!e#s are e#e!ate in E03
2115 $, 'atients- T)e D3imer test ma+ be m$re s'eci,ic in ia%n$sin% DIC. es'ecia##+ in istin%"is)in%
t)e c$a%"#$'at)+ $, #i!er isease ,r$m DIC-
&ed side tests: Be sie tests t$ e!a#"ate t)e b#$$ c$a%"#ati$n is$rers. *)ic) can %i!e "se,"#
in,$rmati$n t)at )e#' in tac/in% t)e crisis- Be sie tests t)at ma+ be $ne are: i- B#eein% time ii-
C#$ttin% time. iii- C#$t $bser!ati$n (Feiber) test- i!- Seria# c#$t #+sis
test !- b#$$ ,i#m-
Screening tests: P#ate#et c$"nt (ecrease). B#eein% time (increase ). Pr$t)r$mbin time(increase).
APTT(increase $r !ariab#e). T)r$mbin time (increase). RBCm$r')$#$%+ (sc)ist$c+tes G
micr$s')er$c+tes)
Differential diagnosis:
DIC *it) $bstetric ca"ses. t)e c#inica# c$niti$ns *)ic) are m$st c$mm$n#+ %i!in% simi#ar c#inica#
'ict"res are t)e ,$##$*in%s:
2- =ELLP s+nr$me
4- Ac"te Li!er 8ai#"re 9 Ac"te ,att+ #i!er in 're%nanc+-
H- Ii$'at)ic9A"t$imm"ne T)r$mb$c+t$'enic P"r'"ra (ITP9ATP)-
?- T)r$mb$tic T)r$mb$c+t$'enic P"r'"ra (TTP)
0- P$st'art"m =aem$#+tic Uraemic S+nr$me (P=US)
I- Primar+ 8ibrin$%en$#+sis-
<- Ac&"ire =em$')i#ia (8act$r 83VIII in)ibit$r)-
Essentials of Diagnosis: N$ sin%#e ia%n$stic test e(ists ,$r DIC- DIC is initia##+ s"%%este b+ t)e
,$##$*in% c$mbinati$n:
J =ist$r+ $, recent b#eein% iat)esis. a#*a+s sec$nar+ t$ s$me ca"se-
J C#inica# e!ience $, m"#ti'#e b#eein% '$ints ass$ciate *it) '"r'"ra 'etec)iae an ecc)+m$sis $n
')+sica# e(aminati$n-
J Lab$rat$r+ ,inin%s c#assica##+ inc#"e t)r$mb$c+t$'enia (D211 (21@9L). 'r$#$n%e PT. APTT an TT.
an 'resence $, 8DP 9 DDimer- Ot)er tests #iste )ere a#s$ ma+ )e#' t$ e(c#"e DIC-
Management:
DIC a#*a+s is t)e en res"#t $, a seri$"s "ner#+in% is$rer- A#t)$"%) t)e 'atient ma+ bene,it %reat#+
,r$m meas"res irecte at t)e DIC $r ,r$m t)e re'#acement $, e'#ete c$a%"#ati$n ,act$rs $r '#ate#ets.
c"re $, t)e s+nr$me e'en $n 'r$m't an ener%etic treatment $, t)e 'rimar+ is$rer- S+m't$ms
$, DIC. a#t)$"%) s$metimes in$#ent. can ca"se #i,e t)reatenin% )aem$rr)a%e an ma+ re&"ire emer%enc+
mana%ement- T)is inc#"es:
I- Detecti$n an e#iminati$n $, 'rimar+ ca"se: It is t)e c$rnerst$ne $, mana%ement $, DIC- Determine t)e
"ner#+in% ca"se an attem't t$ c$rrect it immeiate#+-
II- S"''$rti!e meas"res: Meas"res t$ c$ntr$# t)e ma6$r s+m't$ms. eit)er b#eein% $r t)r$mb$sis-
III- Re'#acement an 'r$')+#actic re%imen: Pre!enti$n $, rec"rrence in cases $, c)r$nic DIC- Treatment
*i## !ar+ *it) t)e c#inica# 'resentati$n- In 'atients *it) an $bstetric c$m'#icati$n s"c) as abr"'ti$
'#acentae. intra"terine ea ,$et"s $r ac"te bacteria# se'sis. t)e "ner#+in% is$rer is eas+ t$ c$rrect. an
'r$m't e#i!er+ $, t)e ,$et"s an '#acenta $r treatment *it) a''r$'riate antibi$tics *i## re!erse t)e DIC
s+nr$me- M$erate an #$* %rae DIC ma+ n$t be ass$ciate *it) c#inica# e!ience $, e(cessi!e
b#eein% an $,ten *i## re&"ire c#$se $bser!ati$n b"t n$ ,"rt)er t)era'+- T)e c$niti$n *i## n$t res$#!e
"nti# t)e tri%%erin% ,act$r is rem$!e. an eat) $, 'atient *it) DIC are $,ten t)e res"#t $, t)e "ner#+in%
isease-
S"''$rti!e t)era'+ s)$"# be irecte t$ t)e c$rrecti$n $, s)$c/. aci$sis. an tiss"e isc)emia-
Cari$'"#m$nar+ s"''$rt. inc#"in% i$n$tr$'ic t)era'+. b#$$ re'#acement. an ass$ciate !enti#ati$n.
s)$"# be im'#emente *it) t)e 'atient in c#$se 'r$(imit+ t$ a e#i!er+ s"ite- Tiss"e 'er,"si$n an
res'irat$r+ ,"ncti$n m"st be maintaine b+ re'#acin% intra!en$"s ,#"i an 'r$!iin% $(+%en t$ c$rrect
)+'$(ia- Parenta# antibi$tic s)$"# be aministere *it)$"t e#a+ *)en bacteria# in,ecti$n is s"s'ecte-
8$eta# m$nit$rin%. care,"# rec$rin% $, materna# ,#"i ba#ance. an seria# e!a#"ati$n $, c$a%"#ati$n
'arameters are e(treme#+ im'$rtant- Patient ma+ be treate *it) b#$$ c$m'$nents t$ re'#ace e'#ete
c$a%"#ati$n ,act$rs. '#ate#et. an nat"ra# in)ibit$rs $, t)r$mbin an '#asmin in an attem't t$ re"ce
b#eein% *)i#e t)e "ner#+in% 'r$b#em is c$rrecte- S'eci,ic re'#acement $, ,ibrin$%en s)$"# be
acc$m'#is)e b+ cr+$'reci'itate- Eac) "nit $, cr+$'reci'itate carries a''r$(imate#+ 411 m% $,
,ibrin$%en- P#ate#et s)$"# $n#+ be aministere in t)e ,ace $, acti!e b#eein% *it) a '#ate#et c$"nt 413
H1>21@9L $r #ess $r ,$##$*in% massi!e b#$$ trans,"si$n *it) st$re $# b#$$- Critica##+ i## 'atients ma+
e!e#$' a c$a%"#$'at)+. beca"se $, !itamin : e,icienc+. an 21 m% $, !itamin : s)$"# be %i!en $n
t*$ c$nsec"ti!e a+s be,$re c$a%"#$'at)+ is attrib"te e(c#"si!e#+ t$ DIC- Patients *it) DIC can a#s$
bec$me !itamin : e,icienc+ beca"se $, itKs increase "se an aministrati$n $, !itamin : t$ a## 'atients
*it) s"s'ecte DIC *i## re'#enis) st$res- S$me $ct$rs a#s$ %i!e ,$#ic aci in $rer t$ 're!ent ac"te
,$#ate e,icienc+ an im'aire '#ate#et 'r$"cti$n-
Va%ina# e#i!er+. *it)$"t e'isi$t$m+ i, '$ssib#e. is 're,erab#e t$ cesarean secti$n- 8ai#"re $,
im'r$!ement in t)e c$a%"#$'at)+ *it)in se!era# )$"rs a,ter e#i!er+ s"%%ests se'sis. #i!er isease.
retaine 'r$"ct $, c$nce'ti$n. $r a c$n%enita# c$a%"#ati$n e,ect-
T)e "se $, )e'arin in t)e treatment $, b#eein% is sti## c$ntr$!ersia#- A#t)$"%) it is a #$%ica# *a+ t$ re"ce
t)r$mbin %enerati$n an 're!ent ,"rt)er c$ns"m'ti$n $, c#$ttin% 'r$teins. it s)$"# be reser!e ,$r
'atients *it) t)r$mb$sis $r t)$se *)$ c$ntin"e t$ b#ee es'ite !i%$r$"s treatment *it) '#asma an
'#ate#ets- Patients *)$ initia##+ )a!e mi# DIC an ma+ n$t be s+m't$matic ma+ be%in t$ b#ee ,$##$*in%
s"r%er+- 8$r e(am'#e. mi# DIC. *it)$"t c#inica# b#eein%. )as been $c"mente "rin% sa#ine $r
'r$sta%#anin3in"ce mitrimester ab$rti$ns- Pr$')+#actic treatment $, 'atients *it) )e'arin ma+
're!ent 'r$%ressi$n $, a mi# DIC s+nr$me an in s$me 'atients a retaine ea ,$et"s t)at re&"ire
s"r%ica# e(tracti$n- =$*e!er m$st 'atients *it) #$* %rae DIC can be mana%e sim'#+ *it) '#asma an
'#ate#et re'#acement an $ n$t re&"ire )e'arin-
Emergenc# care:
J M$nit$r !ita# si%ns: '"#se. b#$$ 'ress"re. res'irati$n. rena# $"t '"t an #e!e# $, c$nsci$"sness-
J D$c"ment e(tent $, )aem$rr)a%e an t)r$mb$sis-
J Determine t)e "ner#+in% ca"se $, t)e DIC an initiate t)era'+-
J Sen b#$$ s'ecimens ,$r a''r$'riate c$a%"#ati$n st"ies an $t)er ia%n$stic #ab$rat$r+ tests-
Screenin% test ,$r DIC are: BT. PT. APTT. P#ate#et c$"nt. RBC m$r')$#$%+-
J Obtain a''r$'riate ima%in% st"ies i, necessar+-
J S"''$rti!e meas"res are essentia#- Atten t$ #i,e t)reatenin% iss"es s"c) as air *a+s c$m'r$mise $r
se!ere )aem$rr)a%e- C$rrecti$n $, ,#"i an e#ectr$#+te imba#ance-
J Re'#ace b#$$ 'r$"cts as inicate: RBC trans,"si$n (i-e- 'ac/e re ce##s). P#ate#et c$ncentrate. 8res)
,r$%en '#asma (88P)- Cr+$'reci'itate-
Consultation:
J C$ns"#t )emat$#$%ist ,$r assistance *it) ia%n$sis an mana%ement-
J C$ns"#t critica# care meicine i, m"#ti'#e $r%ans ,ai#"re is 'resent-
J C$ns"#t trans,"si$n meicine7 etermine t)e a!ai#abi#it+ $, %enera# an s'ecia#i;e b#$$ 'r$"cts t)at
ma+ be necessar+ ,$r t)e ac"te mana%ement $, ,"#minant DIC-
Medication:
T)era'+ s)$"# be base $n eti$#$%+ an aime at e#iminatin% t)e "ner#+in% isease- T)era'+ s)$"# be
a''r$'riate#+ a%%ressi!e ,$r t)e 'atientKs a%e. isease. an t)e se!erit+ an #$cati$n $,
)aem$rr)a%e9t)r$mb$sis- Treatment ,$r ac"te DIC inc#"es antic$a%"#ants. b#$$ c$m'$nents. an
anti,ibrin$#+tics-
=aem$static an c$a%"#ati$n 'arameters s)$"# be m$nit$re c$ntin"$"s#+ "rin% treatment- Base
t)era'e"tic ecisi$ns e'en $n c#inica# an #ab$rat$r+ e!a#"ati$n $, )aem$stasis-
$A% &lood components: B#$$ c$m'$nents are "se t$ c$rrect abn$rma# )aem$static 'arameters- T)ese
'r$"cts s)$"# be c$nsiere $n#+ a,ter initia# s"''$rti!e an antic$a%"#ant t)era'+-
i% Pac!ed red blood cells $'ashed): Pre,erre t$ *)$#e b#$$ since t)e+ #imit !$#"me. imm"ne. an
st$ra%e c$m'#icati$ns- One "nit PRBCs s)$"# raise )aem$%#$bin b+ 2%9# $r raise )aemat$crit b+ H5-
ii% Platelet concentrates: Patient *it) DIC. b#eein% an '#ate#et c$"nts #ess t)an 01>21@9L. s)$"# be
c$nsiere ,$r '#ate#et trans,"si$n- DIC 'atients ma+ re&"ire a )i%)er '#ate#et c$"nt ,$r ae&"ate
)aem$stasis t)en 'atients *it) t)r$mb$c+t$'enia in t)e absence $, '#ate#et +s,"ncti$n (in $t)er
c$niti$ns $, t)r$mb$c+t$'enia se#$m neee '#ate#et trans,"si$n "nti# '#ate#et c$"nt is #ess t)an
41>21@9L)-
iii% (resh (ro)en Plasma $((P%: 88P c$ntains a## t)e c$a%"#ati$n ,act$rs an in)ibit$rs. ATIII
an 'r$tein3C- ? t$ 0 "nits $, 88P s)$"# be ra'i#+ in,"se-
i% Cr#oprecipitate: It c$ntain ,act$r VIIIc. !F8. ,ibrin$%en. ,ibr$nectin an s$me ,act$r >III-
T)e am$"nt $, cr+$'reci'itate %i!en s)$"# be s",,icient t$ e#e!ate t)e '#asma ,ibrin$%en #e!e#
t$ at #east 2113201 m%9#- As a %enera# %"ie. H % $, ,ibrin$%en can be e('ecte t$ raise t)e
'#asma #e!e# $, an a"#t 'atient a''r$(imate#+ 211 m%9#-
&% Anticoagulants:
T)ese a%ents are "se in t)e treatment $, c#inica##+ e!ient intra!asc"#ar t)r$mb$sis *)en t)e 'atient
c$ntin"es t$ b#ee $r c#$t ?3I )$"rs a,ter initiati$n $, 'rimar+ an s"''$rti!e t)era'+- Ta/e s'ecia#
'reca"ti$n in $bstetric emer%encies $r massi!e #i!er-
i% *eparin: T)e inicati$ns ,$r treatment *it) )e'arin an t)e $se re&"ire are n$t estab#is)e42- T)ere
is n$ c$nc#"si!e e!ience t)at )e'arin treatment re"ces m$rta#it+ $r m$rbiit+ in ac"te DIC- =e'arin
treatment ma+ be ine,,ecti!e beca"se it re&"ires antit)r$mbin3III ,$r antic$a%"#ant acti!it+. an t)is is
"s"a##+ re"ce in DIC- T)ere is $ne instance. )$*e!er. *)ere )e'arin )as been em$nstrate t$ bene,it
in 're%nanc+3re#ate DIC- In t)e case $, retaine ea ,$et"s *it) an intact !asc"#ar s+stem. )e'arin ma+
be aministere t$ interr"'t t)e c$a%"#ati$n 'r$cess an t)r$mb$c+t$'enia ,$r se!era# a+s "nti# sa,e
e#i!er+ ma+ be im'#emente-
ii% "o' molecular 'eight+heparin: It is increasin%#+ "se in 're%nanc+ beca"se $, its ,a!$rab#e $sin%
re%imen an #ac/ $, nee ,$r r$"tine m$nit$rin% an #$*ers ris/s $, )aem$rr)a%e. t)r$mb$c+t$'enia an
$ste$'$r$sis- Antit)r$mbin III an Pr$tein3C are $t)er 'r$misin% '$ti$n-
$C% Antifibrinol#tic agents: T)ese are "se $n#+ a,ter a## $t)er t)era'e"tic m$a#ities )a!e been trie
an eeme "ns"ccess,"#- In t)e$r+. e'si#$n3amin$ca'r$ic aci (EACA) an $t)er anti,ibrin$#+tics a%ents
(Trane(amic aci) rem$!e t)e ma6$r anta%$nist $, intra!asc"#ar ,ibrin ,$rmati$n. an in se!era# *e##
$c"mente cases $, DIC. t)eir "se )as res"#te in seri$"s an e!en ,ata# t)r$mb$emb$#ic c$m'#icati$n-
T)e iniscriminate "se $, s"c) r"%s s)$"# be isc$"ra%e-
:$a%"#asi intra!as/"#ar iseminata
(DIC) DALAM PRA:TE: OBSTETRI
Abstra/:
Disseminate intra!asc"#ar c$a%"#ati$n (DIC) aa#a) %an%%"an men%a/"isisi an /$m'#e/s +an% ter6ai
a#am berba%ai /$nisi /#inis- Ini 'aa asarn+a aa#a) /eaaan 'enin%/atan /ecener"n%an "nt"/
be/"an ,$rmasi i'ic" $#e) berba%ai ran%san%an +an% ber)"b"n%an en%an %an%%"an +an% bera%am
se'erti se'sis. en$te# /er"sa/an se# ()eat str$/e. s)$c/). /$m'#i/asi $bstetri/ ('#asenta abr"'ti$. cairan
amni$n emb$#i. 'ree/#amsia berat an mem'erta)an/an intra"terine 6anin mati) an ne$'#asma- DIC
aa#a) /$m'#i/asi /#asi/ /$nisi $bstetri +an% ter6ai i #ebi) ari 01 'ersen 'asien en%an
'en+ebab $bstetri/- Paa DIC. seb"a) #ea/an men+ebab/an tr$mbin ri#is tia/ iat"r tr$mbin %ratis
/e a#am sir/"#asi +an% men%ara) /e ,it"r /#inis DIC. en%an tr$mbin an '#asmin
bertan%%"n% 6a*ab atas mani,estasi tr$mb$ti/ an )em$ra%i/. masin%3masin%- Dia%n$sis
an 'en%$batan sinr$m ini memer#"/an 'ema)aman tentan% 'at$,isi$#$%i. /esaaran
%an%%"an +an% a'at memic" an 'en%a/"an a*a#- DIC a/"t biasan+a ber)"b"n%an en%an
in,e/si. 'en+ebab terserin%. se/itar 213415 'asien en%an se'sis %ram ne%ati, memi#i/i
b"/ti DIC- :r$nis DIC biasan+a i/ait/an en%an mem'erta)an/an 6anin mati. /arsin$mat$sis-
Dia%n$sis sinr$m ini 'aa asarn+a /#inis. en%an tes #ab$rat$ri"m memberi/an /$n,irmasi
b"/ti- Tr$mb$sis mi/r$!as/"#ar aa#a) me/anisme "tama a#am ban+a/ /as"s. an $r%an a/)ir
/e%a%a#an aa#a) 'en+ebab "tama /ematian- Tia/ aa tes ia%n$sti/ t"n%%a# aa "nt"/ DIC- DIC
a*a#n+a isaran/an $#e) /$mbinasi beri/"t7 /$nisi /#inis +an% /$nsisten en%an DIC.
tr$mb$sit$'enia. PT ber/e'an6an%an. APTT. an /e)airan 8DP 9 D3imer- Pen%$batan
ter%ant"n% 'aa 'en+ebab DIC- Paa asarn+a me#ibat/an men%)i#an%/an 'en+ebab misa#n+a.
'en%iriman '#asenta 6i/a i'erta)an/an ata" abr"'te. 'en%iriman 6anin 6i/a i'erta)an/an. 'en%iriman
ce'at 6i/a berat e/#am'sia an seba%ain+a. )istere/t$mi 6i/a 'erara)an tia/ a'at i/$ntr$# ari sit"s
'#asenta- Sete#a) /em"ian. an 9 ata" c$n3saat men%$bati DIC en%an ara) an '#asma trans,"si an
te'at tina/an s"'$rti,- Seba%ai se/"e# ari DIC a'at men%)anc"r/an. a*a# /ec"ri%aan /#inis an
ia%n$sis #ab$rat$ri"m san%at 'entin%- Arti/e# "#asan ini men+eia/an 'e$man 'entin% "nt"/
ia%n$sa +an% te'at an mana6emen /#inis DIC 'aa 'asien /ebianan-
:ata /"nci: :$a%"#asi intra!as/"#ar iseminata (DIC). :ebianan. T)r$mb$sis. ,ibrin. Dimer.
8DP. anti/$a%"#an-
Pen%antar:
:$a%"#asi intra!as/"#ar iseminata aa#a) sinr$m /#inis +an% itanai en%an sistemi/
a/ti!asi /$a%"#asi cascae secara bersamaan men+ebab/an tr$mb"s intra!as/"#ar
,$rmasi (men%$rban/an 'as$/an ara) /e berba%ai $r%an) an /e#e#a)an tr$mb$sit an
,a/t$r /$a%"#asi (+an% men%a/ibat/an 'erara)an)- DIC 6aran% ter6ai teta'i tia/ #an%/a- :e6aian
sinr$m ber!ariasi a#am /aitann+a en%an %an%%"an +an% berbea- Da#am /$nisi /an"n%an.
s$#"si$ '#asenta se'erti an emb$#i cairan /et"ban. DIC ter6ai i #ebi) ari 015 ari
/as"s- Da#am 'ree/#amsia berat DIC ter6ai 'aa <5 'asien. a#am sat" st"i- Diseminata
/$a%"#asi intra!as/"#ar a'at i/#asi,i/asi/an ses"ai en%an /eta6aman an /e'ara)an /#inis7
i) a/"t DIC. ii) S"b3a/"t DIC ata" /r$nis DIC- Pen+ebab /an"n%an DIC a'at i/#asi,i/asi/an seba%ai
a/"t an /r$nis- DIC m"n%/in mer"'a/an )asi# ari /$nisi t"n%%a# ata" %ana- DIC a/"t i
s$#"si$ '#asenta. emb$#i cairan /et"ban. 'ree/#amsia berat ata" e/#am'sia. :ebianan
se'sis. ab$rsi se'ti/ ata" sa#in ab$rsi. 'er#ema/an )ati a/"t 'aa /e)ami#an. #"as
tra"ma bea). trans,"si ara) masi,- s"b3a/"t ata" /r$nis 'aa DIC mem'erta)an/an 6anin mati
s+nr$me. )asi# /$nse'si i'erta)an/an. mer$s$t m$#a )iati$sa. 'er"t
(E/t$'i/) /e)ami#an. %aram ab$rsi. ba%ian ara) ,et$matarna#. '$st'art"m
)em$#iti/ /arsin$ma "reamic s+nr$m metastasis (misa#n+a. $!ari"m)- Per"ba)an )emat$#$%i
se#ama /e)ami#an san%at 'entin%- :e)ami#an n$rma# i/ait/an en%an berba%ai
'er"ba)an "nt"/ /$m'$nen )em$stati/. +an% ber%ab"n% "nt"/ memberi/an 'enin%/atan risi/$
'erara)an. tr$mb$sis an DIC- :e)ami#an i/ait/an en%an 'enin%/atan 4134115 'aa tin%/at
,ibrin$%en an ,a/t$r II. VII. >. VIII an >II. imana /$nsentrasi ,a/t$r V an I> +an%
tia/ ber"ba)- Lai e,e/ bersi) /e)ami#an 'er"ba)an ter/ait a#am )em$stati/ an
'r$tein ,ibrin$#iti/ menin%/at/an risi/$ tr$mb$emb$#i- :isaran n$rma# "nt"/
6"m#a) tr$mb$sit (2013?11 (21@ 9 L) tia/ men%"ba) se#ama /e)ami#an-
Patogenesis DIC adalah !omple!s:
Me/anisme +an% memic" tina/an DIC 'aa 'r$ses a)esi '#ate#et an a%re%asi
an /$nta/ ia/ti,/an (intrinsi/) an ,a/t$r 6arin%an a/ti, (e/strinsi/) 6a#"r
/$a%"#asi- Pr$ses /$m'ensasi n$rma# a'at men6ai cacat. menci'ta/an iri
men%abai/an M#in%/aran setanM- =asi# a/)ir itent"/an $#e) intera/si inamis
antara berba%ai 'r$ses 'at$#$%is an me/anisme /$m'ensasi en%an /ata #ain
e'$sisi ,ibrin ibanin%/an ,ibrin$#isis7 Peni'isan ter)aa' )a# 'en") /$a%"#asi ,a/t$r an
tr$mb$sit7 an 'r$"/si ibanin%/an 'embersi)an ,ibrin. 8DP an 'r$"/ #ainn+a ari /$a%"#asi-
Da#am /eban+a/an bent"/ DIC. ,a/t$r mem"#ai bebera'a an sa#in% ter/ait- DIC a/"t )an+a
)asi# /eti/a me/anisme /$m'ensasi n$rma# )em$stasis te#a)
iatasi- A/ti!asi tr$mb$sit #an%s"n% i se'ticemia an ne%ara !iraemic7 '#ate#et
a/ti!asi 6"%a a/an )asi# ari /er"sa/an inin% 'emb"#") en$te# an tr$mbin beri/"t
%enerasi $#e) /as/ae /$a%"#asi- :$mbinasi e,isiensi ,a/t$r /$a%"#asi.
tr$mb$sit$'enia. %an%%"an ,"n%si tr$mb$sit. an tina/an )ambat men%an%/at 8DP. 'en+ebab
/ecener"n%an 'erara)an #"as "m"m an ber/e#an6"tan- :r$nis ata" M/$m'ensasiM
DIC )asi# ari stim"#"s men%a/ti,/an #ema) ata" intermiten- Paa 'asien terseb"t. 'er"sa/an an
'r$"/si ,a/t$r /$a%"#asi an tr$mb$sit +an% seimban%- It" 'at$,isi$#$%i se'erti /r$nis. s"b3a/"t ata"
M:$m'ensasiM DIC asarn+a sama se'erti +an% i /as"s a/"t- Nam"n emi/ian.
'erbeaan aa#a) ber)ar%a /arena /#inis %ambar an #ab$rat$ri"m tem"an a#am /r$nis
bent"/ +an% c"/"' ber!ariasi an m"n%/in ia%n$sa membin%"n%/an- :r$nis DIC te#a)
i6e#as/an 'aa /eban+a/an 'asien en%an intra"terin /ematian 6anin- 8a/t$r3,a/t$r eti$#$%i #ain +an%
m"n%/in men%)asi#/an DIC /r$nis termas"/ berba%ai bent"/ !as/"#itis. m$#a )iati$sa. an
mer$s$t #ei$mi$ma- :r$nis DIC memi#i/i ban+a/ ,it"r /#inis an #ab$rat$ri"m +an%
men+er"'ai ta)a' 'era#i)an antara MNe%ara )i'er/$a%"#asiM an DIC a/"t- Meman%.
ba)/an /e)ami#an n$rma# te#a) i"s"#/an seba%ai s"at" bent"/ /e#as rena) M,isi$#$%isM DIC +an% 'aa
Isti#a) men6ai terb"/a "nt"/ *a/t" +an% sin%/at-
Pema'aran e/stra/ 6arin%an 'r$c$a%"#ent ara) mer"'a/an ,a/t$r 'en+"mban% "tama i seba%ian besar
bent"/ DIC an ari 'at)$%enetic "tama 'entin% a#am /as"s +an% ter/ait en%an s$#"si$
'#asenta. /ematian 6anin intra"terin. a/"t #e"/emia 'r$m+e#$c+tic. cairan /et"ban
emb$#i. tra"ma masi,. an berba%ai ne$'#asma-

Solusio plasenta: Paa se/itar 21 'ersen ari 'asien en%an s$#"si$ '#asenta. teran%3teran%an
/$a%"#$'ati ber/emban% /arena DIC an ,ibnin$#+sis- Tin%/at se'arat$n '#asenta
ber/$re#asi en%an /e'ara)an DIC- DIC a'at ter6ai 'aa s$#"si$ '#asenta me#ibat/an 'embebasan
ari tr$mb$'#astin 6arin%an ata" m"n%/in :$ns"msi intra"terine ,ibrin$%en an
,a/t$r /$a%"#asi se#ama 'embent"/an %"m'a#an retr$3'#asenta- =a# ini men+ebab/an a/ti!asi
me/anisme /$a%"#asi e/strinsi/-
Emboli cairan !etuban: Beri/"t aa#a) bebera'a /etia/'astian tentan% a'a "ns"r3"ns"r a#am cairan
/et"ban bertan%%"n% 6a*ab "nt"/ sinr$m an a'a/a) 'a'aran sebe#"mn+a an sensitisasi "nt"/ cairan
/et"ban i'er#"/an- Se#"#er e#emen an sam'a) #ainn+a. se'erti ramb"t #an"%$ an !erni(. m"n%/in
'entin%- M"cin ari me/$ni"m a#am cairan /et"ban men+ebab/an Rea/si seba%ian besar ter6ai i 'ar"
arteri$#- Mani,estasi ari /et"ban emb$#i cairan tia/ m"nc"# /e ter%ant"n%
'aa 6"m#a) cairan /et"ban +an% mas"/ sir/"#asi materna# ata" menca'ai sir/"#asi 'ar"3'ar" an $#e)
/arena it" i+a/ini seba%ai res'$n ana,i#a/sis +an% e'enent 'asien- Pat$,isi$#$%i emb$#i cairan /et"ban
mer"'a/an res'$n bi')asic: ta)a' a*a# ter6ai sete#a) cairan /et"ban
memas"/i sir/"#asi 'ar"3'ar" +an% men%a/ibat/an !as$/$nstri/si an )i'ertensi 'ar"7
Ta)a' /e"a aa#a) ta)a' )em$inami/ /$m'r$mi itanai en%an eema an /anan %a%a# 6ant"n% sisi-
Cairan /et"ban men%an"n% /$nsentrasi tin%%i '#asmin$%en 'r$acti!at$rs. teta'i tia/ memi#i/i
'#asmin$%en a/ti!at$r-

,ematian -anin intrauterine: Retensi mati 6anin a'at memic" ib" +an% abn$rma# 'enara)an- :ec"a#i
6anin mati mem'erta)an/an "nt"/ ti%a min%%" ata" #ebi). secara /#inis terb"/ti Gan%%"an %"#ati$n c$a
6aran% ter6ai- T)e DIC ter/ait en%an /ematian 6anin aa#a) /r$nis 'r$ses. an 'asien m"n%/in )air
bai/ seb"a) /$m'ensasi ata" /eaaan e/$m'ensasi- Di intra"terin 6anin /ematian t)r$mb$'#asticn+a
6arin%an ;at ari 6anin mati secara 'er#a)an ta'i ter"s mener"s isera'. men%)asi#/an %ambar /r$nis. ta'i
'r$%resi, DIC-
Pree!lamsia & E!lampsia: +an% te'at eti$#$%i an me/anisme teta' tia/ i/eta)"i- Ini :$nisi
i/ait/an en%an /r$nis /e#ainan /$a%"#asi +an% a'at men+ebab/an tr$mb$sit$'enia an e#e!asi ,ibrin
'r$"/ e%raasi- :$a%"#asi /e#ainan mencermin/an /e'at")an '#ate#et "nt"/ /$#a%en ter'a'ar i #$/asi
/er"sa/an en$te#- =a# ini ter/ait en%an. teta'i 6e#as berbea ari DIC- Pree/#am'sia an e/#am'sia
aa#a) 're/"rs$r +an% tia/ i/eta)"i an tia/ 6e#as /e DIC- Di 'ree/#am'sia an e/#am'sia. 'asien
memi#i/i
6"m#a) +an% #ebi) tin%%i ari 8DP a#am ara) an "rin ari'aa +an% #ain- T)e tr$mb$sit$'enia ter#i)at
'aa 'ree/#am'sia an e/#am'sia aa#a) /arena 'enin%/atan ti$n /$ns"msi tr$mb$sit-

Saline atau aborsi septi!: Sa#ine iin"/si ab$rsi te#a) i/ait/an en%an s"b/#inis DIC- :as"s +an%
'ara) DIC ter6ai i 2:?1132:2111 /as"s- Pen+a/it m"n%/in ber)"b"n%an en%an 'e#e'asan
tr$mb$'#astin 6arin%an ari '#asenta- Ab$rsi se'ti/ 6"%a a'at men+ebab/an 'e#e'asan tr$mb$'#astin
6arin%an ata" 'e#e'asan en$t$/sin ba/teri (,$s,$#i'i)- It" in,e/si "m"m a#am 'ra/te/ /ebianan aa#a)
ab$rsi se'ti/ an /$ri$amni$nitis i 'eca) ini membran- Gramne%ati!e Ba/teri bertan%%"n% 6a*ab
"nt"/ se'ti/ /e6"tan i #ebi) ari @0 'ersen +an% ter/ena am'a/ 'asien-

Trauma besar: Da#am tra"ma besar. besar 'r$se"r bea) se'erti #"/a ter/$+a/ ser!i/s saat me#a)ir/an.
/er"sa/an 6arin%an men%e/s'resi/an a/ti!itas ,a/t$r 6arin%an m"n%/in mer"'a/an ,a/t$r inisiasi "tama-

Infe!si: DIC serin% men+ertai se'ti/emia (Ter"tama /arena Gram3ne%ati,) seba%ai a/ibat ari ab$rsi
se'ti/. ba/teri +an% memi#i/i /"at en$t$/sin-

Shoc!: Ia te#a) men%em"/a/an ba)*a DIC ter#ibat a#am se%a#a bent"/ s)$c/ an ba)*a it" aa#a)
'"sat ,it"r a#am bent"/ ire!ersibe# ata" re,ra/ter-
Presentasi klinis:
,ambaran klinis utama DIC adalah perdarahan, sering serius besar dan onset mendadak, a
elemen variabel shock yang sering keluar dari proporsi kehilangan darah yang jelas, dan gejala
hipoperfusi berbagai tempat tidur vaskular. ,agal ginjal akut adalah umum, dan manifestasi
tromboemboli sering
mencatat. -ukti disfungsi organ utama adalah umum ditemukan pada pasien dengan DIC akut,
paling sering termasuk tanda.tanda, gejala, dan bukti laboratorium paru yang abnormal, ginjal,
hati, dan sistem saraf pusat fungsi. !asalah klinis utama dan penyajian fitur DIC akut adalah
perdarahan, yang dapat bervariasi dari ringan sampai bentuk parah, meujudkan sebagai
memar umum, ecchimosis, petechiae,
terutama daerah lebih tergantung dan tekanan situs dan atau perdarahan dari sebelumnya utuh
situs venipuncture atau sekitar berdiamnya jarum infus. /ada pasien yang mengalami DIC
setelah prosedur bedah, mengkhaatirkan perdarahan dapat terjadi di sekitar saluran air dan
akumulasi darah mungkin tersembunyi di dalam
rongga serosa. Dalam kasus 0ebidanan, post partum pendarahan dari vagina mungkin sangat
parah. /erdarahan yang parah dan hipovolemik syok dapat terjadi sangat cepat dalam
kehamilan, bila biasanya terkait dengan tenaga kerja. Dalam subakut atau kronis DIC, ada
lambat aktivasi sistem hemostatik, dengan memar spontan dan bukan utama episode
perdarahan klinis. $eperti kematian janin intrauterin dapat menghasilkan lambat bentuk
progresif dari DIC, di mana perdarahan merupakan relatif terlambat manifestasi, sering kedepan
dibayangi memburuknya fungsi ginjal.

Laboratorium Diagnosis:
/ada DIC akut, adalah penting untuk menunjukkan parameter laboratorium abnormal akurat
dan cepat, sehingga terapi yang tepat dapat menghasut. The hemostatik utama kelainan
tercermin oleh berkepanjangan aktu trombin, dan hypofibrinogenaemia trombositopenia.
Tingkat fibrinogen di baah '((
%'() * +, dan aktu trombin lebih dari dua kali lipat nilai kontrol dianggap sebagai hampir
diagnostik, terutama jika terkait dengan keadaan perdarahan umum.
Penelitian laboratorium
$A% Dasar Pemeri!saan darah: Pemeri/saan )a'"san ara) men%"n%/a'/an sc)ist$c+t$sis 'aa se/itar
015 /as"s- B"/ti #ebi) )a#"s )em$#isis intra!as/"#ar serin% item"/an. se'erti 'enin%/atan /aar ser"m
#a/tat e)ir$%enase asam (LD=) an tin%/at )e't$%#$bin ber/"ran%- Tr$mb$sit$'enia mer"'a/an tana
a*a# an /$nsisten a/"t 6"m#a) DIC tr$mb$sit a#am /isaran 01 sam'ai 211>21@ 9 L aa#a) tem"an
biasa ta'i tr$mb$sit$'enia bisa berat-

$&% ,oagulasi cacat: T)e 'arsia# Dia/ti,/an *a/t" tr$mb$'#astin (APTT). *a/t" Pr$t)r$mbin (PT).
*a/t" tr$mbin (TT) +an% ber/e'an6an%an i seba%ian besar 'asien en%an DIC a/"t- Paa a*a#
'er6a#anan %an%%"an an i DIC /r$nis. APTT +an% m"n%/in n$rma# ata" ba)/an #ebi) 'ene/ ari
biasan+a- It" /aar '#asma ,ibrin$%en an ,a/t$r V an >III biasan+a secara si%ni,i/an terte/an7
,ibrin$%en an ,a/t$r V aa#a) +an% 'a#in% /$nsisten ter'en%ar")- Paa ban+a/ 'asien ter"tama mere/a
en%an s$#"si$ '#asenta. tin%/at 'r$tr$mbin n$rma# i'erta)an/an nam"n )+'$'r$t)r$mbinaemia
itanai serin% )air 'aa 'asien en%an se'sis- Paa 'asien en%an DIC /r$nis. e,isiensi 'r$tr$mbin
tia/ biasa. i mana /e/"ran%an +an% si%ni,i/an ari 8a/t$r > serin% icatat-

$C% Pengu-ian fibrinolisis: a/ti!itas ,ibrin$#iti/ 'en+ebab men%an%/at tin%/at sir/"#asi ,ibrin /$m'#e/s
an 8DP- Tin%/at i atas 211C%9m# biasan+a item"/an i DIC a/"t (rentan% n$rma# D21C%9m#) 2E- Tes
im"n$#$%i berasar/an antib$i m$n$/#$na# "nt"/ D3imer #ebi) s'esi,i/ ari #a+ar "m"m- Se6a/ 'a#s"
=asi# '$siti, a'at i#i)at en%an 8DP- 8DP tes tia/ ia%n$sti/ ari DIC. nam"n tin%/at +an% menin%/at
'aa E032115 'asien- D3imer tes m"n%/in #ebi) s'esi,i/ a#am menia%n$sis DIC. ter"tama a#am
membea/an /$a%"#$'ati 'en+a/it )ati ari DIC-

Tes side &ed: tes sie Be "nt"/ men%e!a#"asi %an%%"an 'embe/"an ara). +an% a'at memberi/an
in,$rmasi +an% ber%"na +an% membant" a#am mema/" /risis- Tes sam'in% tem'at ti"r +an% m"n%/in
i#a/"/an aa#a): i- Fa/t" 'erara)an ii- Fa/t" 'embe/"an. iii- Be/"an 'en%amatan (Feiber) tes- i!-
Seria# be/"an #isis
Tes ! 8i#m ara)-
Tes s!rining: )it"n% tr$mb$sit (men"r"n). Fa/t" 'erara)an (menin%/at). Pr$t)r$mbin *a/t"
(menin%/at). APTT (menin%/at ata" !ariabe#). Fa/t" tr$mbin (menin%/at). RBCm$r')$#$%+
(Sc)ist$c+tes G micr$s')er$c+tes)

Diagnosis:
DIC en%an 'en+ebab $bstetri/. /#inis /$nisi +an% 'a#in% serin% memberi/an %ambar /#inis +an% ser"'a
aa#a) seba%ai beri/"t:
2- Sinr$m =ELLP
4- :e%a%a#an a/"t Li!er 9 'er#ema/an )ati a/"t 'aa /e)ami#an-
H- Ii$'ati/ 9 a"t$im"n T)r$mb$c+t$'enic P"r'"ra (ITP 9 ATP)-
?- Tr$mb$ti/ T)r$mb$c+t$'enic P"r'"ra (TTP)
0- P$st'art"m )em$#iti/ "remi/ S+nr$me (P=US)
I- Primer 8ibrin$%en$#+sis-
<- Ac&"ire =em$')i#ia (8act$r VIII 83 in)ibit$r)-

Essentials of Diagnosis: Tia/ aa sat" ia%n$sti/ tes aa "nt"/ DIC- DIC a*a#n+a isaran/an $#e)
/$mbinasi beri/"t:
J Se6ara) iatesis 'erara)an bar"3bar" ini. se#a#" se/"ner bebera'a 'en+ebab-
J B"/ti /#inis ari bebera'a 'erara)an '$in +an% ter/ait en%an 'etec)iae '"r'"ra an ecc)+m$sis 'aa
'emeri/saan ,isi/-
J Tem"an #ab$rat$ri"m /#asi/ me#i'"ti tr$mb$sit$'enia (D211 (21@ 9 L). ber/e'an6an%an PT. APTT an
TT. an /e)airan 8DP 9 DDimer- Tes #ain +an% tercant"m i sini m"n%/in 6"%a membant" "nt"/
men%ec"a#i/an DIC-
Mana-emen:
DIC se#a#" mer"'a/an )asi# a/)ir +an% seri"s %an%%"an +an% menasarin+a- Mes/i'"n 'asien m"n%/in
/e"nt"n%an +an% besar ari #an%/a)3#an%/a) +an% iara)/an 'aa DIC ata" ari 'en%%antian )abis ,a/t$r
/$a%"#asi ata" '#ate#et. $bat ari sinr$m ter%ant"n% 'aa ce'at an ener%i/ 'en%$batan %an%%"an
'rimer- Ge6a#a
ari DIC. mes/i'"n /aan%3/aan% ma#as. bisa men+ebab/an 'erara)an +an% men%ancam 6i*a an
a'at memer#"/an mana6emen ar"rat- Ini me#i'"ti:
I- Dete/si an 'en%)a'"san 'rimer men+ebab/an: Ini aa#a) #anasan 'en%e#$#aan DIC- Menent"/an
'en+ebab +an% menasari an menc$ba "nt"/ mem'erbai/in+a se%era-
II- Lan%/a)3#an%/a) "/"n%an: Lan%/a)3#an%/a) "nt"/ men%$ntr$# %e6a#a "tama. bai/ 'erara)an ata"
tr$mb$sis-
III- Pen%%antian an re6imen 'r$,i#a/sis: Pence%a)an /e/amb")an 'aa /as"s /r$nis DIC- Pen%$batan
a/an ber!ariasi en%an /#inis 'resentasi- Paa 'asien en%an /ebianan /$m'#i/asi se'erti s$#"si$
'#asenta. 6anin mati intra"terine ata" ba/teri a/"t se'sis. %an%%"an +an% menasari m"a) benar. an
ce'at 'en%iriman 6anin an '#asenta ata" 'en%$batan en%an te'at antibi$ti/ a/an memba#i//an sinr$m
DIC- Sean% an rena) /e#as DIC m"n%/in tia/ ter/ait en%an b"/ti /#inis +an% ber#ebi)an 'erara)an
an serin%/a#i memer#"/an 'en%amatan e/at teta'i tia/ aa tera'i #ebi) #an6"t- :$nisi ini tia/ a/an
men+e#esai/an sam'ai ,a/t$r 'emic" a/an i)a'"s. an /ematian 'asien en%an DIC serin% a/ibat ari
'en+a/it +an% menasari-

Tera'i s"'$rti, )ar"s iara)/an /e /$re/si s+$/. asi$sis. an 6arin%an is/emia- D"/"n%an
Cari$'"#m$nar+. termas"/ Tera'i i$n$tr$'ic. 'en%%antian ara). an !enti#asi +an% ter/ait. )ar"s
i#a/sana/an en%an 'asien i e/at 'en%iriman s"ite- Per,"si 6arin%an an ,"n%si 'erna,asan )ar"s
i6a%a en%an men%%anti intra!ena cairan an men+eia/an $/si%en "nt"/ mem'erbai/i )i'$/sia-
Parenta# antibi$ti/ )ar"s iberi/an tan'a 'en"naan /eti/a in,e/si ba/teri ic"ri%ai- Pemanta"an 6anin.
re/aman3)ati /eseimban%an cairan ib". an e!a#"asi seri /$a%"#asi 'arameter san%at 'entin%- Pasien
a'at i$bati en%an ara) /$m'$nen "nt"/ men%%anti/an /$a%"#asi )abis ,a/t$r. '#ate#et. an in)ibit$r
a#ami tr$mbin an '#asmin a#am "'a+a "nt"/ men%"ran%i 'enara)an saat masa#a) menasar aa#a)
i/$re/si- Pen%%antian +an% s'esi,i/ ari ,ibrin$%en )ar"s i#a/"/an en%an /ri$'resi'itat- Setia' "nit
/ri$'resi'itat memba*a se/itar 411 m% ,ibrin$%en- P#ate#et se)ar"sn+a )an+a iberi/an a#am
men%)aa'i 'erara)an a/ti, en%an 6"m#a) tr$mb$sit 413H1>21@ 9 L ata" /"ran% ata" men%i/"ti ara)
masi, Trans,"si ara) #ama isim'an- Sa/it /ritis 'asien a'at men%emban%/an /$a%"#$'ati. /arena
/e/"ran%an !itamin :. an 21 m% !itamin : )ar"s iberi/an 'aa "a )ari bert"r"t3t"r"t sebe#"m
/$a%"#$'ati i/ait/an secara e/s/#"si, "nt"/ DIC- Pasien en%an DIC 6"%a a'at men6ai !itamin :
e,isiensi /arena it" 'enin%/atan 'en%%"naan an aministrasi !itamin : "nt"/ sem"a 'asien en%an
"%aan DIC a/an men%isi t$/$- Bebera'a $/ter 6"%a memberi/an asam ,$#at a#am ran%/a "nt"/
mence%a) e,isiensi ,$#at a/"t an %an%%"an 'r$"/si tr$mb$sit-
Persa#inan 'er!a%inam. tan'a e'isi$t$mi 6i/a m"n%/in. aa#a) #ebi) bai/ "nt"/ $'erasi caesar- :e%a%a#an
'enin%/atan /$a%"#$'ati a#am *a/t" bebera'a 6am sete#a) me#a)ir/an men"n6"//an se'sis. 'en+a/it
)ati. 'r$"/ /$nse'si +an% tertin%%a#. ata" /$a%"#asi cacat ba*aan-

Pen%%"naan )e'arin a#am 'en%$batan 'enara)an masi) /$ntr$!ersia#- Mes/i'"n #$%is cara "nt"/
men%"ran%i 'embent"/an tr$mbin an mence%a) :$ns"msi #ebi) #an6"t ari 'r$tein 'embe/"an. it"
)ar"s iseia/an "nt"/ 'asien en%an tr$mb$sis ata" mere/a +an% ter"s berara) mes/i'"n /"at
'en%$batan en%an '#asma an tr$mb$sit- Pasien +an% a*a#n+a memi#i/i DIC rin%an an m"n%/in tia/
%e6a#a m"n%/in m"#ai berara) beri/"t
$'erasi- Misa#n+a. rin%an DIC. tan'a /#inis 'erara)an. te#a) i$/"mentasi/an se#ama sa#ine ata"
'r$sta%#anin3in"ce mitrimester ab$rsi- Pen%$batan 'r$,i#a/sis 'asien en%an )e'arin a'at
mence%a) 'er/emban%an rin%an Sinr$m DIC an 'aa bebera'a 'asien +an% ita)an 6anin mati +an%
memer#"/an e/stra/si bea)- Nam"n /eban+a/an 'asien en%an #$* %rae DIC a'at i/e#$#a )an+a
en%an '#asma an tr$mb$sit 'en%%antian an tia/ memer#"/an )e'arin-

Pera'atan darurat:
J Memanta" tana3tana !ita#: nai. te/anan ara). res'irasi. '"t %in6a# an tin%/at /esaaran-
J D$/"men #"asn+a 'erara)an an tr$mb$sis-
J Menent"/an 'en+ebab ari DIC an mem"#ai tera'i-
J :irim s'esimen ara) "nt"/ te'at St"i /$a%"#asi an ia%n$sti/ #ainn+a tes #ab$rat$ri"m- Tes s/rinin%
"nt"/ DIC aa#a): BT. PT. APTT. tr$mb$sit c$"nt. RBC m$r,$#$%i-
J Mena'at/an 'encitraan te'at 6i/a i'er#"/an-
J Tina/an "/"n%an san%at 'entin%- Men%)airi en%an is"3is" +an% men%ancam /e)i"'an se'erti cara
"ara /$m'r$mi ata" 'erara)an +an% 'ara)- :$re/si cairan an /etia/seimban%an e#e/tr$#it-
J Ganti 'r$"/ ara) ses"ai ini/asi: RBC trans,"si (se# ara) mera) +ait" i/emas). tr$mb$sit
ber/$nsentrasi. se%ar 8r$%en '#asma (88P)- :ri$'resi'itat-

,onsultasi:
J Ber/$ns"#tasi )emat$#$%i "nt"/ bant"an en%an ia%n$sis an mana6emen-
J Ber/$ns"#tasi $bat 'era*atan /ritis 6i/a bebera'a /e%a%a#an $r%an )air-
J :$ns"#tasi/an $bat trans,"si7 menent"/an /eterseiaan "m"m an /)"s"s 'r$"/ ara) +an% m"n%/in
i'er#"/an "nt"/ mana6emen a/"t ,"#minan DIC-
.bat:
Tera'i )ar"s iasar/an 'aa eti$#$%i an it"6"/an "nt"/ men%)i#an%/an 'en+a/it +an% menasarin+a-
Tera'i )ar"s te'at a%resi, "nt"/ "sia 'asien. 'en+a/it. an tin%/at /e'ara)an an #$/asi 'erara)an 9
tr$mb$sis- Pen%$batan "nt"/ DIC a/"t termas"/ anti/$a%"#an. /$m'$nen ara). an
anti,ibrin$#iti/-

=em$stati/ an /$a%"#asi 'arameter )ar"s i'anta" ter"s3mener"s se#ama 'en%$batan- :e'"t"san
tera'e"ti/ asar ter%ant"n% 'aa e!a#"asi /#inis an #ab$rat$ri"m )em$stasis-

$A% !omponen darah: /$m'$nen ara) +an% i%"na/an "nt"/ men%$re/si )em$stati/ n$rma#
'arameter- Pr$"/3'r$"/ ini )ar"s ian%%a' )an+a sete#a) a*a# men"/"n% an tera'i anti/$a%"#an-

i% Di!emas sel darah merah $dicuci%: Pre,erre "nt"/ se#"r") ara) /arena mere/a membatasi !$#"me.
/e/eba#an t"b"). an /$m'#i/asi 'en+im'anan- Sat" "nit PRC )ar"s menin%/at/an )em$%#$bin $#e)
2%9# ata" menin%/at/an )emat$/rit sebesar H5-

ii% trombosit !onsentrat: Pasien en%an DIC. 'erara)an an 6"m#a) tr$mb$sit /"ran% ari 01>21@ 9 L.
)ar"s i'ertimban%/an "nt"/ trans,"si tr$mb$sit- Pasien DIC m"n%/in memer#"/an '#ate#et +an% #ebi)
tin%%i men%)it"n% "nt"/ )em$stasis +an% memaai ma/a 'asien en%an tr$mb$sit$'enia tan'a aan+a
is,"n%si tr$mb$sit (a#am /$nisi #ain tr$mb$sit$'enia 6aran% ib"t")/an '#ate#et trans,"si sam'ai
6"m#a) tr$mb$sit /"ran% ari
41>21@ 9 L)-

iii% Segar &e!u Plasma $((P%: 88P men%an"n% sem"a ,a/t$r /$a%"#asi an in)ibit$r. ATIII
an 'r$tein3C- ? sam'ai 0 "nit 88P )ar"s ce'at iin,"s-

i% ,riopresipitat: Ini men%an"n% ,a/t$r VIIIc. !F8. ,ibrin$%en. ,ibr$ne/tin an bebera'a ,a/t$r >III-
L"m#a) /ri$'resi'itat +an% iberi/an )ar"s c"/"' "nt"/ menin%/at/an tin%/at ,ibrin$%en '#asma
setia/n+a 2113201 m% 9 #- Seba%ai 'an"an "m"m. H % ,ibrin$%en a'at i)ara'/an "nt"/
menin%/at/an
tin%/at '#asma ari 'asien e*asa se/itar 211 m% 9 #-

&% Anti!oagulan:
A%en ini i%"na/an a#am 'en%$batan tr$mb$sis intra!as/"#ar terb"/ti secara /#inis /eti/a 'asien ter"s
berara) ata" men%%"m'a# ?3I 6am sete#a) im"#ain+a 'rimer an men"/"n% tera'i- Men%ambi#
tina/an 'ence%a)an /)"s"s a#am /ebianan /eaaan ar"rat ata" )ati besar-

i% *eparin: Ini/asi "nt"/ 'en%$batan en%an )e'arin an $sis +an% ib"t")/an tia/ estab#is)e42-
Tia/ aa b"/ti /$n/#"si, ba)*a 'en%$batan )e'arin men%"ran%i /ematian ata" m$rbiitas 'aa DIC
a/"t- Pen%$batan )e'arin m"n%/in tia/ e,e/ti, /arena memer#"/an antitr$mbin3III "nt"/ a/ti!itas
anti/$a%"#an. an ini biasan+a ber/"ran% 'aa DIC- Aa sat" Misa#n+a. ba%aimana'"n. i mana )e'arin
te#a) terb"/ti man,aat a#am /e)ami#an ter/ait DIC- Da#am /as"s ita)an 6anin mati en%an sistem
!as/"#ar "t"). )e'arin m"n%/in iberi/an "nt"/ men%%an%%" /$a%"#asi 'r$ses an tr$mb$sit$'enia
se#ama bebera'a )ari sam'ai 'ersa#inan +an% aman a'at iim'#ementasi/an-

ii% /endah berat mole!ul+heparin: Ini aa#a) sema/in i%"na/an a#am /e)ami#an /arena si,atn+a
men%"nt"n%/an re6imen $sis an /"ran%n+a /eb"t")an "nt"/ 'emanta"an r"tin an men"r"n/an risi/$
'erara)an. tr$mb$sit$'enia an
$ste$'$r$sis- Antitr$mbin III an Pr$tein3C +an% #ain men6an6i/an ram"an-

$C% agen Antifibrinol#tic: ini i%"na/an )an+a sete#a) sem"a m$a#itas tera'i #ainn+a memi#i/i te#a)
ic$ba an ian%%a' ber)asi#- Secara te$ri. e'si#$n3amin$/a'r$at aci (EACA) an #ainn+a a%en
anti,ibrin$#iti/ (asam trane/samat) men%)a'"s anta%$nis "tama intra!as/"#ar 'embent"/an ,ibrin. an i
bebera'a s"m"r
/as"s i$/"mentasi/an DIC. 'en%%"naann+a memi#i/i men%a/ibat/an seri"s an ba)/an ,ata#
/$m'#i/asi tr$mb$emb$#i- It" 'en%%"naan sembaran%an $bat terseb"t )ar"s ber/eci# )ati-