Name
DIC
DESCRIPTION
DETAIL
ETIOLOGIC FACTORS & DISORDERS CAUSING DIC : 1. LIBERATION OF TISSUE FACTORS : - OBSTETRIC SYNDROMES LIKE ABRUPTIO PLACENTAE, AMNIOTIC FLUID EMBOLISM, RETAINED DEAD FETUS, SECOND TRIMESTER ABORTION - HEMOLYSIS - NEOPLASMS , PARTICULARLY MUCINOUS ADENOCARCINOMAS, AC PROMYELOCYTIC LEUKEMIA - INTRAVASCULAR HEMOLYSIS - FAT EMBOLISM - TISSUE DAMAGE - BURNS, FROSTBITE, HEAD INJURY, GUN SHOT WOUNDS 2. ENDOTHELIAL DAMAGE - AORTIC ANEURYSM - HEMOLYTIC UREMIC SYNDROME - AC GLOMERULONEPHRITIS - ROCKY MOUNTAIN SPOTTED FEVER 3. VASCULAR MALFORMATION & DECREASED BLOOD FLOW - KASABACH - MERRITT SYNDROME 4. INFECTIONS * BACTERIAL - STAPHYLOCOCCAL, STREPTOCOCCAL, PNEUMOCOCCAL, MENINGOCOCCAL & GRAM NEGATIVE BACILLI * VIRAL - ARBOVIRUSES, VARICELLA, VARIOLA, RUBELLA * PARASITIC - MALARIA , KALA AZAR * RICKETTSIAL - ROCKY MOUNTAIN SPOTTED FEVER * MYCOTIC - AC HISTOPLASMOSIS -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Massive hepatic necrosis β’ Vitamin K deficiency β’ Thrombocytopenic purpura β’ Hemolytic-uremic syndrome β’ Primary fibrinolysis* THROMBOCYTOPENIA & PRESENCE OF SCHISTOCYTES OR FRAGMENTED RBCS * PT & PTT & THROMBIN TIME - PROLONGED * PLASMA FIBRINOGEN LEVEL - DECREASED * FIBRIN DEGRADATION PRODUCTS - ELEVATED * D DIMER IMMUNOASSAY WHICH SPECIFICALLY MEASURES CROSS LINKED FIBRIN DERIVATIVES, IS MORE SPECIFIC FDP ASSAY. * CLOTTING FACTORE II , V , VIII & X , XIII - DECREASED. * ANTITHROMBIN III - DECREASED * FIBRINOLYSIN TEST & FIBRINOPEPTIDE A - INCREASED * BLEEDING TIME - INCREASED * ANEMIA & LEUKOCYTOSIS * LDH & BUN - INCREASED β’ Hemoglobinemia β’ Hematuria β’ Guaiac-positive stools β’ Decreased protein C IMAGING : Chest x-ray: Bilateral perihilar soft density
TYPENOTES
RISK FACTORS β’ Pregnancy β’ Prostatic surgery β’ Head injury β’ Infl ammatory statesGENERAL MEASURES β’ Treat underlying condition e.g., evacuation of uterus in abruptio placenta. Broad-spectrum antibiotics for gramnegative sepsis. β’ Replacement of blood loss β’ Platelet concentrates β’ Fresh frozen plasma β’ Cryoprecipitate β’ Antithrombin III concentrate β’ Anticoagulants DRUG(S) OF CHOICE : β’ Anticoagulants (heparin) if clinical findings suggest developing thrombotic complications, but never after head injury ALTERNATIVE DRUGS : For DIC associated with metastatic prostatic carcinoma, consider heparin, aminocaproic acid (Amicar). Do not use fi brinolytic inhibitors (Amicar) unless severe fi brinolysis is documented. β’ Broad-spectrum antibiotics for sepsis PATIENT MONITORING : Closely until much improved PREVENTION/AVOIDANCE : No preventive measures known POSSIBLE COMPLICATIONS: β’ Acute renal failure β’ Shock β’ Cardiac tamponade β’ Hemothorax β’ Intracerebral hematoma β’ Gangrene and loss of digits EXPECTED COURSE/PROGNOSIS : Related to severity of cause of DIC AGE-RELATED FACTORS : Pediatric: Neonatal purpura fulminans associated with DIC and protein C or protein S deficiency (homozygous)
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
PLATELET COUNT, BLEEDING TIME, CLOTTING TIME, PROTHROMBIN TIME, PARTIAL THROMBOPLASTIN TIME, THROMBIN TIME, FIBRINOGEN, COMPLETE BLOOD COUNT, FIBRIN DEGRADATION PRODUCTS