dic in english

7/30/2019 DIC in English

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Disseminated Intravascular Coagulation

Tutik Harjianti,SpPD,K-HOMSubDiv.of Hematology & Medical Oncology

Dept.of Internal Medicine, Medical Faculty

Hasanuddin University


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Sub Topics :

I. Introducton of D.I.C.

II. Trigger Mechanism of D.I.C.

III. Etiology of D.I.C.

IV. Clinical pictures of D.I.C.

V. Diagnosis of D.I.C.VI. Management of D.I.C.

VII. Prognosis of D.I.C.


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Physiology of blood circulation :

Blood always in a liquid form

Vascular disruption initiate coagulation

( as a part of normal hemostasis )

Coagulation is limited in area of lesion

by the effect of :

- blood streaming / blood flow- coagulation inhibitor inside the circulation

(esp. Anti Thrombin III / AT III)


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Why DIC can be occured ?

Overstimulation of coagulation

suppresion of control mechanism

DIC.


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Important Clue :

The presence ofthrombin circulating in

bloodline.

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Normally : thrombin can only be found in

area of lesion (where the coagulation

process is still running)


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Result of excess of thrombin

1. Decreased of fibrinogen

2. Decreased of platelet

3. Decreased of coagulation factors

4. Exaggerated of fibrinolysis


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II. TRIGGER MECHANISM OF D.I.C :

TUMORTissue TRAUMATissueNECROSIS

RELEASE OFTISSUE FACTORINTO CIRCULATION

DIC1

2 ENDOTOXINGRAM NEGATIVE BACT. ACTIVATION ofCOAGULATION

CASCADE

(F XII)

DIC

EXPRESSION OFTISSUE FACTORin MONOCYTE &ENDOTHELIALcells

ACCELERATION of COAG RX


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III. ETIOLOGY of D.I.C.

DIC is not a stand alone disease entity

As a result of severe disease or condition

- Sepsis : gram +, gram -, & fungal infection

Tissue necrosis : (trauma & combustio/burn)

Obstetric : (abortus, emboli of liquor amnion,

fetal death)

Malignancy : (leukemia: Ca)


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DIC

- Oftenly undiagnosed

- Unexplained bleeding usually lead the

clinician to think about D.I.C.


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Coagulation disorders in DIC .

Thrombosis can be occurred if the abnormality

of coagulation more prominent than fibrinolysis

- digital ischaemia- gangrene (necrosis)

- Necrosis of cortex of kidney

- Adrenal gland necrosis & bleeding


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Trousseau Syndrome

Subacute DIC

Oftenly found in cancer patients

Thrombosis in superficial & profundal

veins (DVT), commonly recurrent


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V. Diagnosis of D.I.C.

1. Clinical pictures (severe disease,

bleeding, thrombosis)

2. Laboratory : fibrinogen

platelet actvated Partial Thromboplastin

Time (aPTT) >


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Differential Diagnosis of DIC :

1. Liver Diseases (normal fibrinogen )

2. Vit K defc (normal fibrinogen & platelet)


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VI. Management of DIC :

Treat the underlying disease/condition.

Replacement Tx

1. Platelet concentrate transfusion

(maintain the platelet > 50.000 / mm3)

2. Cryoprecipitate transfusion

(maintain the fibrinogen > 150.000 mg/dL)


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Management.

3. Fresh Frozen Plasma transfusion

(to increase coagulation factors)

4. Heparin : still controversial

Should be given with Replacement Tx

Dose : 500750 u / hour


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TERIMA KASIH


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VII. Prognosis of DIC

Depends on :

1. severity of coagulation reaction

2. amount of bleeding

3. etiology of DIC (malignancy etc)


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Action of Plasmin :

- fibrin degradation product (FDP) formed

- inactivation of f V & f VIII

- fibrin degradation


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Thrombin :

Fibrinogen conversion fibrin monomer

Stimulation of platelet aggregation

Activation off V & f VIII

Release ofplasminogen activator plasmin

formation.

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