ISTH International Society
on
Thrombosis and Haemostasis
ISTH
Russian Association on Thrombosis
Haemostasis and Vascular Pathology
n.a. A.A.Schmidt-B.A.Kudryashov
First Moscow State Medical University
n.a. I.M.Setchenov
RUSSIAN ASSOCIATION ON THROMBOSIS,
HEMORRAGE AND VASCULAR PATHOLOGY
named after А. А. SCHMIDT - B.А.KUDRYASHOV
ISTH International Society on
Thrombosis and Haemostasis EDUCATIONAL COURSE
Thrombosis, Thrombophilias, DIC and Thrombolytic Therapy.
Moscow17-19 September 2014
YOU
ARE
WELCOME !!!
DICand
HOW WE UNDERSTAND
it in RUSSIA
I.N.BokarevMoscow
ISTH EDUCATIONAL COURSE
17.09.2014
TFPITFPI
AT AT
APC
APC
XIIa XII
Kallikrein Prekallikrein
HMWK
Tissue factor molecule
НАРУШЕНИЯ ГЕМОКОАГУЛЯЦИИ
ВЫЗЫВАЮТ:
ГЕМОРРАГИИ
ТРОМБОЗЫ
ДВС-СИНДРОМ
ИНТЕНСИВНОСТЬ ВНУТРИСОСУДИСТОГО
МИКРОСВЕРТЫВАНИЯ КРОВИ
МОЖНО ОПРЕДЕЛИТЬ
на основании измерения
фибринопептида А
D-димера
b - тромбоглобулина
4-го фактора тромбоцитов
DIC
Syndrom
Волтер Сиггерс 1910-1996
The reasons of my presentation:
1. To restrict the unnecessary use
the DIC expression, to remind how it
was originated.
2. To resolve debatable questions on
definitions and detection of DIC
by introducing the conception of the
Constant Intravascular Microcoagulation.
3. Stop to use the term
“hypercoagulability”
The reasons of my presentation:
1. To restrict the unnecessary use
the DIC expression, to remind
how it was originated. 2. To resolve debatable questions on
definitions and detection of DIC
by introducing the conception of the
Constant Intravascular Microcoagulation.
3. Stop to use the term
“hypercoagulability”
DIC - is a very dangerous state.
For the Doctor the DIC diagnosis requires
a very quick actions, because the patient
can die during several hours .
Prevalence of DIC
• People who arrive to hospital 1 in 1000
G. Мuller-Веrghaus
1 in 867 J.Zilbut
• Acute leukemia - 15-20%
• Septicemia (if it is Gram-negative or Gram-positive microbes) - 30-50%
• Severe injury - 50-70 %M. Levi
D. McKay
Term of DIC was proposed in USA by young American pathologist Donald МсКау in 1950 , when he made the autopsy. D. МсКау discovered a lot of thrombus in the vessels in the body of woman, who had died in obstetric hospital because of bleeding disorders. He proposed the term-Disseminated Intravascular Coagulation which was coined.
The senior collegues of D.McKay - С.Schneider and W. Siggers made public this term. The term DIC - syndrome got wide use in medicine after 4th American congress of obstetricians in 1951 where С.Schneider and W. Siggers reported the case of D.McKay.
Walter Siggers 1910-1996
Schneider CL. “Fibrin embolism”(disseminated intravascular coagulation) with defibrination as one of the end results during placenta abruptio.
Surg.Gynec.Obstet.92:27-34. Jan 1951
Schneider CL: Fibrin embolism (disseminated intravascular coagulation) and the etiology of eclampsia. J. Obst. Gynaec. Brit Emp. 58: 538-554.Aug.1951
DIC attracted high attention of the medicine
By :
1. Its dangerous to the life
2. Unusual way of development-
thrombosis induced bleeding
- Н. Lasch - consumption coagulopathy
- H. Selye and М.Machabeli - thrombo-hemorragic syndrom
- С. Оwen and W. Воwie - Intravascular blood coagulation and fibrinolysis
С. Оwen in his experimental works with the animals, when he infused thromboplastin to the dogs, had got not the bleeding, but increase some of the procoagulant in their blood. Those data allowed him to say, that the DIC may be the chronic- and from those time appeared new term- the “Chronic DIC-syndrome”. It was done in 1970-th.
The reasons of my presentation:
1. To restrict the unnecessary use
the DIC expression, to remind how it
was originated.
2. To resolve debatable questions on
definitions and detection of DIC
by introducing the conception of the
Constant Intravascular Microcoagulation.
3. Stop to use the term “hypercoagulability”
Types of the DIC- syndrome
• Compensated and decompensated DIC G. Мuller-Веrghaus
• Chronic, subacute, Acute DIC С. Оwen
• Evident and latent DIC F.Тауlor
• Pre-DIC• Consumption Coagulopathy - Н. Lasch • Thrombo-hemorragic syndrom - H. Selye and М.Machabeli ,
The finding of D.McKay and C.Owen very much stimulated the investigation of the process of fibrin formation.
By B. Blomback, M. Blomback, B. Lipinsky and V. Gurevich, U. Abildgaard, P. Gaffney, S. Niewiarovsky, K.Rucinski and others. was proposed the methods to detect FDP, soluble fibrin-monomer, D-dimer, β-thromboglobulin, the platelets factor - 4 and at last TPP, for the investigation of the fibrin formation.
And the investigations in this area began to be done.
The possibility of determination the markers of fibrin-formation and the activity of platelets component of blood coagulation made it possible to found out the difference in their intensity and to suggest that they are relatively independent from each other.
Investigations, that we had done on the large body of patients with chronic pathology, gave us the information about the fibrin formation and platelet activity as the parts of intravascular microcoagulation at patients with different diseases.
We studied the state of intravascular fibrin
formation with the help of TPP( thrombus protein precursor), which detect the fibrin-monomer without fibrinopeptids А and В. We took the patient with the opposite clinical picture- thrombosis and bleeding. The level of TPP was measured at the patients with acute coronary syndrome and at the hemophiliac.
In the blood of people, who had the hemophilia, the level of TPP was higher, than it was at the healthy people
INTENSITY OF INTRAVASCULAR MICROCOAGULATION MAY BE
MEASURED BY the level of:
Fibrinopeptide- A
D-dimer
b - thromboglobulin
Platelet factor- 4
Constant intravascular microcoagulation
Constant presence of the markers of intravascular coagulation in plasma of healthy and sick people gave us the reason to think, that the intravascular microcoagulation of the blood is going permanently, and there is need to show its existence by the term “Constant intravascular microcoagulation”- CIMC .
Grades OF the CONSTANT INTRAVASCULAR MICROCOAGULATION
of BLOOD
1-st grade
NORMAL CIMC
Levels of CIMC markers are “ normal” .
2-nd grade
TRANSIENT
INCREASED CIMC
Levels of CIMC markers increased, but it is unstable and does not produce special clinical changes in the main disease picture.
3-d grade
SUSTAINED
INCREASED CIMC
Levels of CIMC-markers is increased. This state is stable, but does not have special clinical manifestations. There is hope,that Its regulation may be important and may increase the positive outcome of the disease.
4th grade
CIMC-
DIC-SYNDROM
Increase of the constant intravascular coagulation is going sharply and produce the impact on the organs function, threatening to the life of the patients ( DIC-syndrom)
DEFINITION of DIC
DIC is the phenomena of acute and intensive formation of intravascular microclots, that are generated in the microvessels level. They can get different morphologic structure, different forms of clinical manifestation and lead to acute dysfunction of organs and
tissues is the threat to life.
Constant intravascular microcoagulation
DIC-syndrome is only the highest stage of CIMC, where the increase of its intensity is an independent cause of the damage of body-organs and body-tissues and may manifest itself by the bleeding, multiple organ damage, hypotony, micro- and macro- thrombosis and its different combinations.
It may be used by the doctor in the following way:
- He will know, that the blood in the body is clotting constantly, and that the patients with the chronic disease every time have the permanent increase of the blood clotting. The term “ hypercoagulation” is unnecessary.
- Doctor must know, that the possibility of thrombosis depends from the main disease and from the ability of the patients blood to coagulate
(thrombophilia).
CIMC conception
resolves all debatable questions on definition and get the practicaly useful information about DIC
There is no need to look for the chronic DIC, as the clotting of blood is going constantly.
The reasons of my presentation:
1. To restrict the unnecessary use
the DIC expression, to remind how it
was originated.
2. To resolve debatable questions on
definitions and detection of DIC
by introducing the conception of the
Constant Intravascular Microcoagulation.
3. Stop to use the term
“hypercoagulability”
Identification of the level of the markers of the intravascular blood microcoagulation couldn’t help to the doctor to predict the speed of progress of increasing of intravascular microcoagulation for reaching the 4-th stage of CIMC, which is the synonym of the acute DIC.
At each morbid events which characterized by high risk of DIC’s development, such as sepsis and other infections, neoplasms, traumatic and surgical tissue damage, obstetrical pathology, vascular lesions and vessels anomaly, autoimmune diseases, allergic reactions, the expectation of the development of DIC by the doctors must be constant. Only than it will be possible to do the right and early recognition of DIC.
Diagnosis of DIC
• Level of fibrinogen • Level of platelets
Progressive reduction of their level in combination with the clinical picture should be the reason for diagnosis of DIC and for the beginning of therapy.
We HOPE, that the use of the conception of Constant Intravascular Micro Coagulation will help You to treat Your patients.
Thank You
For Your Attention !