Disseminated Intravascular Coagulation

by / Tuesday, 22 June 2010 / Published in Internal Medicine

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  • Characterized by abnormal activation of the coagulation sequence, leading to formation of microthrombi throughout the microcirculation
  • Causes a consumption of platelets, fibrin, and coagulation factors
  • Fibrinolytic mechanisms are activated, leading to hemorrhage
  • THEREFORE, BLEEDING AND THROMBOSIS OCCUR SIMULTANEOUSLY
  • Is most commonly seen in critically ill patients who are usually in the ICU, but can occur in healthy patients as well
  • Can be acute and fatal, or a more gradual process

CAUSES:

  • Infection due to gram (-) sepsis
  • Obstetric Complication
  • Major tissue surgery – Trauma, Burns, Fractures
  • Malignancy – Lungs, pancreas, prostate, GI tract, Acute Promyelocytic Leukemia
  • Shock + circulatory collapse
  • Snake Venom

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CLINICAL FEATURES:

  • Bleeding Tendency – Superficial hemorrhages, bleeds from the GI/GU tract, and oozing from procedure sites
  • Thrombosis – occurs MC in chronic cases, end-organ infarct may develop
  • ALL TISSUES AT RISK EXCEPT CNS AND KIDNEY

DIAGNOSIS:

  • Incrases in PT, PTT, Bleeding Time, TT, fibrin split products, and D-dimer
  • Decreases in fibrinogen level and platelets
  • The peripheral smear shows schistocytes from RBC damage

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TREATMENT:

  1. Management of all underlying conditions
  2. Supportive measures when severe hemorrhage presents
  • FFP replaces all clotting factors
  • PLT transfusion
  • Cryoprecipitate replaces clotting factors and fibrinogen
  • Low dose heparin (IV or subQ) can inhibit clotting and prevent consumption of clotting factors
  • Additional supportive measures such as 02, IV fluids (maintain blood pressure)

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