Disseminated Intravascular Coagulation N Engl J Med, Volume 3418' Aug 19'1999

1
Disseminated Intravascular CoagulationN Engl J
Med, Volume 341(8). Aug 19.1999

• Review articles by Levi
• From the Department of Vascular medicine ad
  internal medicine, Academic Medical Center,
  University of Amsterdam

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Character

• Widespread activation of coagulation
  intravascular formation of fibrin nd thrombotic
  occlusion of small and midsized vessels
• Depletion of platelets and coagulation proteins
  induces severe bleeding

3
Associated Clinical Conditions

• Sepsis
• Trauma
• Cancer
• Obstetrical comlications
• Vascular disorder
• Reactions to toxin
• Immunological disorder

4
Sepsis

• Bacterial infection is most frequently related to
  DIC
• DIC may occur in 30 to 50 of patientswiht gram
  negative sepsis
• Incidence of DIC is similar in G() sepsis
• Triggers are cell-specific membrane components of
  the microorganism, or bacterial exotoxin

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Severe Trauma

• Particularly to the brain
• Mechanisms release of fat and phopholipids in to
  circulation, hemolysis, endothelial damage.
  Systemic activation of cytokines has a pivotal
  role.
• 50 to 70 in patients who have SIRS as
  consequences

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Cancer

• Solid tumors (e.g pancreatic cancer, prostate
  cancer) and myeloproliferative diseases
• The incidence is 10 to 15
• Triggers Tissue factor
• acute promyelocytic leukemia severe
  hyperfibrinolytic state in addition to an
  activated coagulation system.

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Obstetrical Disorders

• Abruptio placenta, amniotic fluid embolism
• Leakage of thromboplastin-like material
• The incidence is 50
• Preeclampsia 7

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Vascular disorder

• Giant hemangioma, aortic aneurysms
• Local activation of coagulations results in
  systemic depletion of locally consumed
  coagulation factors and platelets
• The incidence is 25 and 1 respectively

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Reaction to Toxin

• Snake venom
• Drugs
• Amphetamines

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Immunoloical Disorders

• Severe allergic reaction
• Hemolytic transfusion reactions
• Transplant rejections

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D/D with Microangiopathic hemolytic Anemia

• Thrombocvtopenic thrombotic purpura
• Hemolytic uremic syndrome
• Malignant hypertension
• HELLP syndrome
• Endothelial damage adhesion and aggregations
  of platelets, formation of thrombin,impairment of
  thrombolysis.
• Fragmented RBCs is the cardinal sign