Disseminated intra vascular coagulation

Disseminated intra vascular coagulation

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  DISSEMINATED INTRA VASCULAR COAGULATION PRESENTEDBY R.PRIYA
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  INTRODUCTION Disseminated intravascular coagulation(DIC) is a syndrome characterised by systemic intravascular activation of coagulation, leading to the widespread deposition of fibrin, with formation of widespread microvascular thrombosis. These microthrombi impair organ perfusion and thus contribute to organ failure. During the coagulation process, consumption of coagulation factors and aggregation of platelets occur resulting in reduced levels of both procoagulant and anticoagulant clotting proteins. Therefore patients with DIC may have both thromboembolic events and hemorrhage.
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  DEFINITION Disseminated intravascular coagulation(DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Disseminated intravascular coagulation (DIC) is a serious disorder in which the proteins that control blood clotting become overactive.
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  TYPES  ACUTE  CHRONIC
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  CAUSES •Cancer: solid tumoursand blood cancers (particularly acute promyelocytic leukaemia) •Complications of pregnancy: abruptio placentae, pre- eclampsia or eclampsia, amniotic fluid embolism, retained intrauterine fetal demise, septic abortion, postpartum haemorrhage •Massive tissue injury: trauma, burn, hyperthermia, rhabdomyolysis, surgery •Infection: bacterial (Gram-negative or Gram-positive), viral, fungal, or protozoan •Transfusion reaction: ABO incompatibility •Allergic or toxic reaction: snake venom •Haemangioma: Kasabach–Merritt syndrome •Aortic aneurysm
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  RISK FACTOR •undergone surgery •delivereda baby •had an incomplete miscarriage •had a blood transfusion •had anesthesia •had sepsis or any other fungal or bacterial blood infection •had certain types of cancer, especially certain types of leukemia •had serious tissue damage such as a head injury, burns, or trauma •had liver disease
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  SIGNS AND SYMPTOMS •Bruising,which may appear easily, and often in various areas as small dots or larger patches •Bleeding at the site of wounds from surgical cuts or from placement of a needle •Bleeding from the nose, gums, or mouth, including when you brush your teeth •Blood in the stools from bleeding in the intestines or stomach. Stools may appear dark red or like tar. •Blood in the urine •Chest pain, trouble breathing, and shortness of breath •Confusion, speech changes or trouble speaking, dizziness, or seizures •Headaches • Low blood pressure •Pain, redness, warmth, and swelling in the lower leg •Unusually heavy periods •rectal or vaginal bleeding •red dots on the surface of the skin (petechiae)
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  DIAGNOSTIC EVALUATION • History •physicalexam to look forsigns and symptoms of blood clots, bleeding, •Blood clotting tests, such as prothrombin time (PT) and partial thromboplastin time (PTT), to measure how well and how long it takes your blood to clot. If how long it takes your blood to clot. If you have DIC, your clotting time may be longer than normal. •Complete blood count (CBC) to measure the number of red blood cells, white blood cells, and platelets in your blood. If you have DIC, the numbers of blood. If you have DIC, the numbers of platelets, red cells, or both may be low. •Comprehensive metabolic panel (CMP) to measure your kidney function, liver function, and the sugar and electrolyte levels in your blood. Abnormal results electrolyte levels in your blood. Abnormal results could indicate that DIC caused damage to your kidneys or liver or could identify another underlying condition that caused your DIC. •D-dimer tests to look for blood clots. The test measures D-dimer, a substance that is released in the blood when blood clots dissolve. D-dimer levels may be blood clots dissolve. D-dimer levels may be high if you have DIC. •Peripheral blood smear to look at the number, size, and shape of your platelets and other blood cells. In a peripheral blood smear, a small amount of your blood smear, a small amount of your blood is examined under a microscope. The presence of damaged red blood cells may suggest DIC. Serum fibrinogen tests to measure how much fibrinogen is in your blood. Fibrinogen is a protein that helps the blood clot and may be low if you have DIC. A
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  DIAGNOSTIC EVALUATION . •Global coagulationresults • Platelet count (> 100k = 0, < 100k = 1, < 50k = 2) • Fibrin degradation products such as D-Dimer (no increase = 0, moderate increase = 2, strong increase = 3) • Prolonged prothrombin time (< 3 sec = 0, > 3 sec = 1, > 6 sec = 2) • Fibrinogen level (> 1.0g/L = 0; < 1.0g/L = 1)
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  MANAGEMENT •Transfusions of plateletsor fresh frozen plasma can be considered in cases of significant bleeding, or those with a planned invasive procedure. The target goal of such transfusion depends on the clinical situation. Cryoprecipitate can be considered in those with a low fibrinogen level. Treatment of thrombosis with anticoagulants such as HepClotting factor replacement such as fibrinogen. This is used to stop bleeding. •Oxygen therapy to allow more oxygen to reach the lungs, the heart, and the rest of the body if blood clots are preventing oxygen from reaching •Plasma transfusion, which provides clotting factors, to stop or prevent bleeding. •Platelet transfusion to quickly raise platelet levels to stop or prevent bleeding. arin is rarely used due to the risk of bleeding.
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  COMPLICATION •Acute respiratory distresssyndrome (ARDS) •Bleeding from the gastrointestinal tract (GI tract) or elsewhere in the body if you have acute DIC. This is not common in chronic DIC, since clotting develops more slowly, and your body can make enough platelets and clotting factors. •Heart attack, if a blood clot blocks or limits blood flow to your heart •Multiple organ failure, if blood clots prevent oxygen from reaching your organs. These organs can include the lungs and kidneys, followed by the brain, heart, liver, spleen, adrenal glands, pancreas, and the GI tract. •Shock •Stroke, if a blood clot blocks or limits blood flow to your brain, or if there is bleeding in the brain •Venous thromboembolism (VTE), which can include blood clots in the lungs, called pulmonary embolism, or in the deep veins of the legs, called deep vein thrombosis