Difference between revisions of "Disseminated intravascular coagulation"

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{{Thrombocytopenia}}
 
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==Diagnosis==
 
==Diagnosis==

Revision as of 12:42, 10 June 2015

Background

  • Widespread and inappropriate activation of the coagulation and fibrinolytic systems
    • Exposure of blood to procoagulants such as tissue factor and cancer procoagulant
    • Formation of fibrin within the circulation
    • Fibrinolysis
    • Depletion of clotting factors
    • End-organ damage
  • Chronic DIC occurs when hepatic/bone marrow production balances coag factor consumption

Causes

Clinical Features

In given pt either bleeding or thrombosis will predominate (bleeding is more common ~65%)

  • Shock (15%)
  • Acute renal failure (25-40%)
  • Hepatic dysfunction (19%)
  • Respiratory dysfunction (16%)
  • Thromboembolism (7%)
  • CNS involvement (2%)
  • Purpura fulminans (widespread arterial and venous thromboses)
    • Associated with significant bacteremia

Differential Diagnosis

  • TTP-HUS
    • Pts usually have little or no prolongation of PT or PTT
  • Severe liver disease
    • Also a/w prolonged PT/PTT, thrombocytopenia, incr D-dimer, incr FDPs
      • However, D-dimer is usually only mildly elevated

Thrombocytopenia

Decreased production

Increased platelet destruction or use

Drug Induced

Comparison by Etiology

ITP TTP HUS HIT DIC
↓ PLT Yes Yes Yes Yes Yes
↑PT/INR No No No +/- Yes
MAHA No Yes Yes No Yes
↓ Fibrinogen No No No No Yes
Ok to give PLT Yes No No No Yes

Coagulopathy

Platelet Related

Factor Related

Diagnosis

Acute

  • Platlets
    • Low (or dropping)
    • Sn, not Sp
  • PT
    • Prolonged
  • Fibrinogen
    • Low
    • <100 correlates w/ severe DIC
    • May be normal (acute phase reactant)
  • PTT
    • Prolonged
  • FDP
    • Elevated
  • D-dimer
    • Elevated
    • Sn but not Sp: may also see in pts w/ chronic liver or renal disease
  • RBCs
    • Fragmented (not specific)

Chronic

  • FDP: Elevated
  • D-dimer: Elevated
  • Platelet: Variable
  • Fibrinogen: Normal-elevated
  • PT: Normal
  • PTT: Normal
  • RBCs
    • Fragmented

Treatment

  • Treat underlying illness
  • Replacement tx
    • Only indicated in pts w/ documented DIC + bleeding or impending procedure
      • Fibrinogen
        • Consider repletion w/ cryoprecipitate to raise level to 100-150
      • Platelets
        • Consider repletion if <50K w/ bleeding or <20K without bleeding
      • FFP
      • Vitamin K
      • Folate
    • Heparin
      • Consider only in pts w/ thromboembolic predominant symptoms from chronic DIC

See Also

References