Coagulation, intravascular disseminated

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Coagulation, intravascular disseminated

Disseminated intravascular coagulation (DIC) is a syndrome that occurs in various diseases and is characterized by the formation of insoluble fibrin in the blood and the utilization of procoagulants and platelets with the development of hemorrhagic and / or thrombotic syndromes. The division into phases of hyper- and hypocoagulation is not entirely correct, because. both processes proceed simultaneously and the presence of clinical manifestations of

Classification

    • Acute DIC (generalized) is characterized by a pronounced hemorrhagic syndrome due to acute thrombocytopenia and depletion of plasma coagulation factors. Possible deposition of fibrin in the microvasculature and the occurrence of hemorrhagic necrosis
    • Subacute DIC – thromboembolic syndrome is more typical, bleeding is less common.

Etiology

    • Release of tissue factors
    • obstetric syndromes
    • Placental abruption
    • Amniotic fluid embolism
    • Stillbirth
    • Abortion in the second trimester of pregnancy
    • Hemolysis (in the so-called intravascular)
    • Oncological diseases, especially mucin-producing adenocarcinomas and acute promyelocytic leukemia
    • Fat embolism
    • tissue damage
    • burns
    • Frostbite
    • TBI
    • gunshot wounds
    • Endothelial damage
    • aortic aneurysm
    • Hemolytic uremic syndrome
    • Acute glomerulonephritis
    • Blue disease
    • Vascular malformations and reduced tissue perfusion
    • Infections.

Risk factors

    • Pregnancy
    • Surgical interventions on the prostate gland
    • TBI
    • Inflammatory conditions. Pathogenesis
    • Depletion of coagulation factors and platelets – tendency to bleed
    • Formation of fibrin deposits in the microvasculature
    • tendency to bleed
    • Ischemic damage to organs
    • Microangiopathic hemolytic anemia.

Clinical picture

    • Increased bleeding (more common)
    • Thrombotic disorders
    • acrocyanosis
    • Preganrenous changes in the fingers, external genitalia, nose
    • Cough
    • Dyspnea
    • Localized rales in the lungs
    • Tachypnea
    • Rubbing noise of the pleura
    • Confused mind, disorientation
    • Oliguria, anuria
    • Sometimes with chronic DIC (for example, with malignant neoplasms), the absence of increased bleeding and thrombosis is likely.

Laboratory research

    • Complete blood test – thrombocytopenia, anemia, leukocytosis, schizocytosis
    • Coagulogram
    • Increased PTT
    • Increased PV
    • Decreased fibrinogen content
    • Increasing the content of fibrin breakdown products
    • Decreased levels of antithrombin III
    • Increasing bleeding time
    • Decrease in the content of factors V, VIII (probably also its increase), X, XIII
    • Reduced protein C
    • Biochemical blood test – an increase in the content of LDH, urea, hemoglobin-mia
    • General urine test – hematuria
    • Positive Gregersen test.

Special research methods – X-ray examination of the chest organs reveals bilateral basal enhancement of the pulmonary pattern.

Differential Diagnosis

    • Massive liver necrosis
    • Vitamin K deficiency
    • Thrombocytopenic purpura
    • Hemolytic uremic syndrome.

Treatment:

Goals

    • An attempt to influence the reversible causes of DIC
    • Antibacterial therapy for sepsis
    • Delivery, removal of the uterus with placental abruption
    • Correction of disorders that have arisen (hemorrhagic or thrombotic)
    • For bleeding, fresh frozen plasma, platelet mass
    • With signs of thrombosis – intravenous heparin
    • In the subclinical course of DIC – heparin IV, transfusion of platelet mass and fresh frozen plasma (effective for preventing further progression of DIC)
    • Prevention of the recurrence of DIC is long-term heparin therapy.

Complications

    • OPN
    • Shock
    • Cardiac tamponade
    • Hemothorax
    • Intracerebral hematoma.

Current and forecast. Lethality – 50-80%. Depends on the severity of the underlying disease that caused the development of DIC (with placental abruption complicated by DIC – less than 1%, with shock and infection – more than 90%). Synonym. Defibrinization syndrome See also placental abruption, preterm ICD D65

Literature

  • Syndromes of disseminated intravascular coagulation. Vorobyov PA. Moscow: Newdiamed-AO, 1994
  • Diagnosis and treatment of disseminated intravascular coagulation. Lychev VG. M.: Medicine, 1993