Disseminated Intravascular Coagulation
Widespread generation of fibrin within blood vessels
Clinical Features
- patient ill, shocked
- bleeding ranges from none to widespread haemorrhage
- mouth
- nose
- venepuncture sites
- ecchymoses
- thrombotic events
- skin and kidney most often affected
Pathology
- activation of coagulation cascade by
- release of coagulant material
- diffuse endothelial damage
- generalised platelet aggregation
- Role of activation of leukocytes, monocytes - releasing tissue factor /
cytokines
- Consumption of
- platelets
- coagulation factors
- Production of fibrin degradation product (FDPs)
- may inhibit fibrin polymerisation
Causes
- malignant disease
- septicaemia
- haemolytic transfusion reactions
- obstetric causes
- abruptio placentae
- amniotic fluid embolism
- trauma
- burns
- surgery
- other infections
- Plasmodium falciparum (malaria)
- snake bite
Investigations
- PT, PTTK, TT severely prolonged
- fibrinogen level markedly reduced
- high levels of FDPs
- severe thrombocytopenia
- fragmented red cells
Mild cases
- increased synthesis may restore clotting, thrombocytes to normal
- FDPs raised
Treatment
- Underlying condition
- maintenance of blood volume / tissue perfusion
- as necessary
- (rarely) heparin to interrupt intravascular coagulation
- protein C / antithrombin in selected patients
Reference - Kumar & Clark p407
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