Difference between revisions of "Disseminated intravascular coagulation"

(Treatment)
(Differential Diagnosis)
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**Also a/w prolonged PT/PTT, thrombocytopenia, incr D-dimer, incr FDPs
 
**Also a/w prolonged PT/PTT, thrombocytopenia, incr D-dimer, incr FDPs
 
***However, D-dimer is usually only mildly elevated
 
***However, D-dimer is usually only mildly elevated
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 +
{{Hemolytic anemia DDX}}
  
 
{{Thrombocytopenia}}
 
{{Thrombocytopenia}}

Revision as of 12:51, 29 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

Microangiopathic Hemolytic Anemia (MAHA)

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 treatment
    • Only indicated in with documented DIC + bleeding or impending procedure
    • Heparin
      • Consider only if thromboembolic are predominant symptoms from chronic DIC

See Also

References