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fibrin degradation products and prolonged prothrombin time .Disseminated Intravascular Coagulation (DIC) Essential of Diagnosis y Comsumptive thrombocytopenia y Underlying serious illness y Macrioangiopathic hemolytic anemia may be present y Hypofibrinogenemia. thrombocytopenia.
especially metastatic tumors and hematologic y Tissue factor involved in mechanism . viral. activation of cytokines Malignancy y Solid tumors. LPS Trauma & Burns y Soft tissue injury. parasitic. mycotic y Triggered by membrane components of microorganism.Disseminated Intravascular Coagulation (DIC) Causes Infection/septicemia y Any microorganism ± bacterial. hemolysis. exotoxin. rickettsial. head injury y Combination of triggers: fat. endothelial injury. fat embolism. endotoxin. phospholipids.e. i.
new hope´ 2003:327:974-77. BMJ. 2nd trimester abortion y Due to leakage of thromboplastin-like material y Degree of placental separation correlates with severity of DIC y Usually short-lived and self-limited Levi. Marcel MD and Cate. . causing DIC Organ destruction y Pancreatitis. hepatic failure Toxins y Snake bite. 1999. Cheng Hock. ³Disseminated Intravascular Coagulation: Old disease. Hugo MD. NEJM ³Disseminated Intravascular Coagulation´ Aug 19. drugs Immunologic mediators y Transfusion reaction. activated factors reach systemic circulation. retained deceased fetus. amniotic fluid embolism. aortic aneurysm y Local activation of coagulation leads to systemic depletion of factors. transplant rejection Obstetrical complications y Abruptio placentae. Toh. Vascular disorders y Hemangioma (Kasabach-Merritt syndrome). Vol 341:586-592.
DIC Overwhelming production of Thrombin and Fibrin Deposition of Fibrin in vasculature Inadequate Fibrinolysis Thrombotic or microangiopathic vasculopathy Organ damage(clot -ischemia) Exhausting the Bone marrow and liver synthetic capability Thrombocytopenia and decreased coag.factors Mucosal bleeding(GI). oozing from IV puncture sites .
C.I. DIFFUSE FIBRIN DEPOSITION WIHIN ARTERIOLES AND CAPILLARIES WIDESPREAD CLOTTING DEPLETION OF CLOTTING FACTORS .D.
C.I.Disseminated Intravascular Coagulation (D.) Mechanism Systemic activation of coagulation Intravascular deposition of fibrin Depletion of platelets and coagulation factors Thrombosis of small and midsize vessels with organ failure Bleeding .
snake venom. drugs) Immunologic disorders y Severe allergic reaction y Transplant rejection Malignancy Obstetrical complications y Amniotic fluid embolism y Abruptio placentae .I.Common clinical conditions associated with D. Sepsis Trauma y Head injury y Fat embolism Vascular disorders Reaction to toxin (e.g.C.
D. Laboratory Hypofibrinogenemia Elevated fibrin degradation products. Ddimer Thrombocytopenia Prolonged PT and possible PTT Fragmented RBCs in slide .C.I.
reduced Vitamin K deficiency: will not affect Fibrinogen or Plt. PT/PTT. Diff.count. Fibrinogen level may be normal or only sl.I.DX Liver disease-abn.D.C. will correct with vitamin K therapy Sepsis: fibrinogen level is normal TTP: fibrinogen level is normal .
Medical Treatment approaches Treatment of underlying disorder with heparin Anticoagulation Platelet Fresh transfusion frozen plasma .I.D.C.
cryoprecipitates Anticoagulants y Heparin or LMWH± contradictory results Safety in patients prone to bleeding? Low dose 300-500U/hr Likely of benefit in patients with extensive thromboemboli and fibrin deposition y Danaproid sodium. recombinant hirudin y TFPI Blocks tissue factor activity in endotoxin-induced DIC y Recombinant nematode anticoagulant protein c2 (NaPc2) ± inhibits complex between TF/VIIa and Xa .Treatment TREAT THE UNDERLYING DISEASE!! Replacement therapy y Fresh frozen plasma **preferred y Platelets. fibrinogen concentrates.
Davis-Jackson. 4:4. 4:7. 2006. Rachel. diagnosis and treatment of disseminated intravascular coagulation´ Feb 2006. Thrombosis Journal ³Recent acquisitions in the pathophysiology. Massimo. Restore anticoagulation pathway y Antithrombin III Might be of benefit in sepsis with improvement of DIC and organ function y Recombinant tissue plasminogen activator y Activated protein C Also has anti-inflammatory and anti-apoptotic properties Only anti-coagulant shown to be efficacious in trials with sepsis-triggered DIC Given as 96 hr infusion Must use caution with thrombocytopenia increased risk of intracerebral hemorrhage Frachini. Thrombosis Journal ³Antithrombin III and R-TPA used singly and in combination vs. supportive care for treatment of endotoxin-induce DIC in the neonatal pig´ May 18. .