DIC

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Information about DIC
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Published on February 24, 2009

Author: aSGuest13712

Source: authorstream.com

Disseminated Intravascular Coagualation(DIC) : Disseminated Intravascular Coagualation(DIC) It is an acquired coagulation disorder resulting from excessive activation of the coagulation system leading to thrombohemorrhagic disorder & multiple organ failure This epiphenomenona almost always secondary to some other illness Severity of the disease often exceeds than its primary cause. . : It is an acquired coagulation disorder resulting from excessive activation of the coagulation system leading to thrombohemorrhagic disorder & multiple organ failure This epiphenomenona almost always secondary to some other illness Severity of the disease often exceeds than its primary cause. . INTRODUCTION Etiology : Etiology INFECTIONS – Gram Neg , Meningococcal & Cl welchi Septicemia, Severe falciparum malaria,Viral infections. MALIGNANCY – Widespread mucin secreting adenocarcinoma,Ca breast,Ca prostate, Acute promyelocytic leukaemia. OBSTETIC COMLICATIONS – Amniotic fluid embolism,Premature separation of Placenta,Retained placenta,dead fetus,Hydatidiform mole. Etiology(contd.) : Etiology(contd.) HYPERSENSITIVITY REACTIONS : Anaphylaxis, Mismatched Blood Transfusion. WIDESPREAD TISSUE DAMAGE : Crush Injury following Surgery & Trauma, Severe Burn. MISCELLANEOUS : Liver failure, Snake bite, Heat stroke, Acute hypoxia, Vascular malformations(Kasbach Mariff Syndrome),Massive transfusion.Fat embolism. PATHOPHYSIOLOGY : PATHOPHYSIOLOGY Slide 6: DIC triggered by Intrinsic Pathway Endothelial damage & Collagen Exposure Extrinsic Pathway Entry of PROCOAGULANTS Through Tissue injury Amn fl Embolism Premature placenta separation AML M3 Falciparum malaria Haem Trans Reaction Liver Disease Snake bite etc Endotoxemia Gram neg septecinia Septic abortion Viral Diseases Severe Burn Hypothermia etc` Mucin secreting Adeno carcinoma Release of PROCOAGULANTS through tissue injury or endothelial injury(Cytokines,IL6,TNF,etc)Activation of Coagulation CascadeSmall & Large vessel THROMBOSIS leading to multiple organ ischemia & failureConsumptive Coagulopathy : Release of PROCOAGULANTS through tissue injury or endothelial injury(Cytokines,IL6,TNF,etc)Activation of Coagulation CascadeSmall & Large vessel THROMBOSIS leading to multiple organ ischemia & failureConsumptive Coagulopathy Activation of Fibrinolytic System Bleeding from Multiple sites PLASMIN Qualitative & quantitative Platelet Abn. Clinical Presentations : Clinical Presentations Clinical manifestation of Dic are extremely variable. They not only depend on features of the underlying disease, but they also vary with the evolving clinical picture. : Clinical manifestation of Dic are extremely variable. They not only depend on features of the underlying disease, but they also vary with the evolving clinical picture. The major clinical features of DIC are : @ Bleeding. @Hypotension & shock may be out of proportion to the apparent blood loss. @Thrmboembolic manifestation & acute renal failure are often noted. @ Evidence of major organ dysfunction eg, pulmonary, renal, & CNS is very common in DIC. : The major clinical features of DIC are : @ Bleeding. @Hypotension & shock may be out of proportion to the apparent blood loss. @Thrmboembolic manifestation & acute renal failure are often noted. @ Evidence of major organ dysfunction eg, pulmonary, renal, & CNS is very common in DIC. Meningococcemia on the leg : Meningococcemia on the leg DIC may exist either in acute or in chronic from depending upon : 1) The compensatory capacity of the liver & bone marrow to replace the coagulation factors respectively 2) the severity of the ongoing disease process. : DIC may exist either in acute or in chronic from depending upon : 1) The compensatory capacity of the liver & bone marrow to replace the coagulation factors respectively 2) the severity of the ongoing disease process. ACUTE DIC: ØBleeding manifestation of virtually every kind. ØGeneralised echymoses, petechie, bleeding from venipuncture sites, gum bleeding, epistaxis GIT Bleeding,hematuria. ØLarge spreading haemrrhagic skin lesions. Ø“Geographical” acral cyanosis characterized by grayish discolouration of the tips of the fingers, toes & ears. ØPulmonary haemorrhage & haemorrhage in the serous cavities. : ACUTE DIC: ØBleeding manifestation of virtually every kind. ØGeneralised echymoses, petechie, bleeding from venipuncture sites, gum bleeding, epistaxis GIT Bleeding,hematuria. ØLarge spreading haemrrhagic skin lesions. Ø“Geographical” acral cyanosis characterized by grayish discolouration of the tips of the fingers, toes & ears. ØPulmonary haemorrhage & haemorrhage in the serous cavities. Slide 17: Meningococcemia on the calves LAB Findings – Moderate to serve thrombocytopenia, prolonged PT & aPTT & Thrombin time, decreased fibrinogen, factor V & VII.FDP – Positive : LAB Findings – Moderate to serve thrombocytopenia, prolonged PT & aPTT & Thrombin time, decreased fibrinogen, factor V & VII.FDP – Positive Slide 19: Meningococcemia associated purpura CHRONIC DIC:ØIntermittent echymosis & petechie may persist for weeks or months.ØRecurrent epistaxis, mucosal bleeding of less severity.Ø“Trouseau’s sign” – recurrent migratory thrombophlebitis associated with carcinoma.ØUsually associated with malignancies (eg, mucin secreting adenocarcinoma.)ØMay switched on to acute form when compensatory mechanism fails due to stress eg, surgery. : CHRONIC DIC:ØIntermittent echymosis & petechie may persist for weeks or months.ØRecurrent epistaxis, mucosal bleeding of less severity.Ø“Trouseau’s sign” – recurrent migratory thrombophlebitis associated with carcinoma.ØUsually associated with malignancies (eg, mucin secreting adenocarcinoma.)ØMay switched on to acute form when compensatory mechanism fails due to stress eg, surgery. LAB Findings – Mild to serve thrombocytopenia, normal to slightly prolongedPT, normal to short aPTT, modertory decreased, normalor high fibrinogen, normal factor V & VII. FDP – Positive : LAB Findings – Mild to serve thrombocytopenia, normal to slightly prolongedPT, normal to short aPTT, modertory decreased, normalor high fibrinogen, normal factor V & VII. FDP – Positive Different Diagnosis :ØHaemolytic uremic SyndromeØIdiopathic Thembocytopenic PurpuraØSevere liver failure (most common differential disorder)ØIdiopathic purpura fulminansØPrimary fibrinolysis (Platelet remains normal in most of the cases)ØVitamin K deficiencyØHemolysis, elevated liver function, and low platelets (HELP) syndrome in pregnancy. : Different Diagnosis :ØHaemolytic uremic SyndromeØIdiopathic Thembocytopenic PurpuraØSevere liver failure (most common differential disorder)ØIdiopathic purpura fulminansØPrimary fibrinolysis (Platelet remains normal in most of the cases)ØVitamin K deficiencyØHemolysis, elevated liver function, and low platelets (HELP) syndrome in pregnancy. Slide 23:  Treatment : : Treatment : Because of the diverse etiologies and clinical manifestations of DIC, proper management must be highly individualized. The therapeutic goal should be ü Treatment of the underlying disease without delay. Ü Replacement of deficient clotting components and control of coagulation disorder. Ü Prophyactic regimen to prevent recurrence in cases of chronic DIC. : Because of the diverse etiologies and clinical manifestations of DIC, proper management must be highly individualized. The therapeutic goal should be ü Treatment of the underlying disease without delay. Ü Replacement of deficient clotting components and control of coagulation disorder. Ü Prophyactic regimen to prevent recurrence in cases of chronic DIC.

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