Disseminated Intravascular Coagulation Final (Komed)

8/6/2019 Disseminated Intravascular Coagulation Final (Komed)

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DISSEMINATED

INTRAVASCULARCOAGULATIONDokter Magang Interna FK UNPAD

RSUD Karawang


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Definition

An acquired sydrome where coagulation system

and/or fibrinolytic is activated systematically that

cause coagulation intravascular that exceed natural

anti coagulant mechanism


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Hemostasis Review

Patophysiology of Hemostasis:

Primary Hemostasis :

VascularPlatelet

Secondary Hemostasis :

Coagulation Factor


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Hemostasis Review

Primary Hemostasis:

Vascular Vasoconstriction


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Hemostasis Review

Platelet Adhesion and Agreggation


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Hemostasis Review

Secondary Hemostasis: Coagulation Factor

fibrinogenfibrin


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Hemostasis Review

Secondary Hemostasis


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Hemostasis Review

Antithrombotic counter-regulation

Thrombomodulin

Blocks coagulation

t-PA

Fibrinolysis


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Hemostasis Review

Hemostasis Balance

Procoagulant Anticoagulant

Clotting Factors

Tissue factor*

Antiplasmin

PAI-1

ATIII

Fibrinolytic System

TFPI

Prot. C

Prot. S


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Pathophysiology of DIC

- Activation of blood coagulation

- Suppression of physiologic anticoagulant pathways

-

Impaired fibrinolysis


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Pathophysiology of DIC

Systemic activation of coagulation

Intravascular

deposition of

fibrin

Thrombosis ofsmall and

midsize vessels

Depletion ofplatelets and

coagulation

factors

Bleeding

Organ failure


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Conditions Associated with DIC

- Infectious/septicemia

- Malignancy

-

Obstetric- Tissue injury

- Intravascular hemolysis

- Acute liver disease


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Clinical Manifestations of DIC

ORGAN ISCHEMIC HEMOR.

Skin Pur. FulminansGangreneAcral cyanosis

Petechiae

EchymosisOozing

CNS Delirium/ComaInfarcts

Intracranialbleeding

Renal Oliguria/AzotemiaCortical Necrosis

Hematuria

Cardiovascular MyocardialDysfxn

Pulmonary Dyspnea/HypoxiaInfarct

Hemorrhagiclung

GIEndocrine

Ulcers, InfarctsAdrenal infarcts

Massivehemorrhage.


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Clinical Manifestations of DIC


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Diagnosis of DIC

- Presence of disease associated with DIC

- Appropriate clinical setting

clinical evidence of thrombosis, hemorrhage, orboth

- Laboratory studies

serial test are more helpful than single test


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Laboratory Test Used in DIC

- Platelet count

- Prothrombin time

-

aPTT- Thrombin time

- D-dimer

- Antithrombin III

- Fibrinogen

- Fragment

Prothrombin 1+2

-

Fibrin degradationproduct

- Platelet factor 4

- Protamine test

- Reptilase time


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Laboratory diagnosis in DIC

Prolongation of prothrombin time

Prolongation of activated partial thromboplastin

time

Decrease in platelet count

Peripheral smear examination: schistocytes

Decrease in fibrinogen

Low levels of coagulation factors

Decrease in factor V, Decrease in factor VIII


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Laboratory diagnosis of DIC

Increase in D-dimer

Increase in prothrombin fragment 1+2

Increase in fibrinopeptide A Increase in fibrinopeptide B

Increase in thrombin-antithrombin complex


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Differential Diagnosis

- Severe liver failure

- Vitamin K deficiency

-

Liver disease- Thrombotic thrombocytopenic purpura

- Congenital abnormalities of fibrinogen

- HELLP syndrome


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Treatment of DIC

Stop the triggering factor

Supportive therapy

Plasma and platelet substitution therapy Anticoagulants

Physiologic coagulation inhibitors


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Plasma Therapy

Fresh Frozen Plasma

- Provides clotting factors, fibrinogen, inhibitors, and

platelets in balanced amounts.

- Usual dose is 10-15 ml/kg

Indications:

- Active bleeding

- Patient at high risk for bleeding complications


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Platelet therapy

Platelets

approximate dose 1 unit/10 kg

Indications- Active bleeding

- Patient at high risk for bleeding complications


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Blood

Replaced as needed to maintain adequate oxygen

delivery.

Blood loss due to bleeding

RBC destruction (hemolysis)


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Coagulation Inhibitor Therapy

Antithrombin III

Protein C concentrate

Tissue Factor Pathway Inhibitor (TFPI)

Heparin


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Heparin

Use is very controversial.

Indicated in patients with clinical evidence of fibrin

deposition or significant thrombosis.

Possible indicated in Retained Death Fetus

Syndrome, Aorta Aneurysm, Acute Promyelocytic

Leukemia

Dose of heparin is determined by clinicalmanifestation

Disseminated Intravascular Coagulation Final (Komed)

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