Difference between revisions of "DIC"
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=Most Common Etiologies= | =Most Common Etiologies= | ||
+ | * Top three etiologies: infection, malignancy, and trauma/surgery, each account for 10-20% of cases. | ||
* '''Bacterial sepsis''' (83%), '''Trauma''' (31%), '''Cancer''' (e.g. APML, 6.8%), placental abruption, preeclampsia, amniotic fluid embolism, burn, hyperthermia, rhabdomyolysis, infection, transfusion reaction (ABO incompatibility), snake venom, aortic aneurysm | * '''Bacterial sepsis''' (83%), '''Trauma''' (31%), '''Cancer''' (e.g. APML, 6.8%), placental abruption, preeclampsia, amniotic fluid embolism, burn, hyperthermia, rhabdomyolysis, infection, transfusion reaction (ABO incompatibility), snake venom, aortic aneurysm | ||
+ | |||
=Pathogenesis= | =Pathogenesis= | ||
− | * Expression of the transmembrane glycoprotein TF (which activates factor VII and the extrinsic pathway) | + | * '''Exposure''': Expression of the transmembrane glycoprotein TF (which activates factor VII and the extrinsic pathway) |
− | * Consumption of clotting factors | + | * '''Coagulation''': Consumption of clotting factors; Widespread micro and macrovascular thrombosis, depletion of fibrinogen and fibrin clot formation; Platelets are trapped in the clots |
− | + | * '''Fibrinolysis''': Plasminogen --> Plasmin also upregulated, leading to large increase in clot breakdown and release of [[FDPs]] such as D-dimer. Leads to worsened bleeding. | |
− | |||
− | * Plasminogen --> Plasmin also upregulated, leading to large increase in clot breakdown and release of [[FDPs]] such as D-dimer. | ||
=Diagnostic Algorithm= | =Diagnostic Algorithm= | ||
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* PT > 3s (1 pt), > 6s (2 pt) | * PT > 3s (1 pt), > 6s (2 pt) | ||
* Fibrinogen < 1 g/L (1 pt) | * Fibrinogen < 1 g/L (1 pt) | ||
+ | |||
+ | Compared with the non-DIC group, the DIC group had prolonged K time, decreased α angle, increased R value, and decreased CI and MA value (P<0.05). With increase of SOFA scores, R value and K value increased significantly, and α angle, MA value, and CI decreased significantly (P<0.05). According to TEG, platelet function and fibrinogen function of DIC patients were significantly reduced, and the body showed hypocoagulability. (PMID: 30988714) | ||
=Treatments= | =Treatments= |
Latest revision as of 16:23, 23 October 2022
Most Common Etiologies
- Top three etiologies: infection, malignancy, and trauma/surgery, each account for 10-20% of cases.
- Bacterial sepsis (83%), Trauma (31%), Cancer (e.g. APML, 6.8%), placental abruption, preeclampsia, amniotic fluid embolism, burn, hyperthermia, rhabdomyolysis, infection, transfusion reaction (ABO incompatibility), snake venom, aortic aneurysm
Pathogenesis
- Exposure: Expression of the transmembrane glycoprotein TF (which activates factor VII and the extrinsic pathway)
- Coagulation: Consumption of clotting factors; Widespread micro and macrovascular thrombosis, depletion of fibrinogen and fibrin clot formation; Platelets are trapped in the clots
- Fibrinolysis: Plasminogen --> Plasmin also upregulated, leading to large increase in clot breakdown and release of FDPs such as D-dimer. Leads to worsened bleeding.
Diagnostic Algorithm
Score of 5+ points strongly associated with DIC
- Presence of a disease known to be associated with DIC (2 pts)
- Platelets < 100k (1 pt), < 50k (2 pt)
- Fibrin degradation products (FDPs) (e.g. d-dimer): moderate increase (2 pt), strong increase (3 pt)
- PT > 3s (1 pt), > 6s (2 pt)
- Fibrinogen < 1 g/L (1 pt)
Compared with the non-DIC group, the DIC group had prolonged K time, decreased α angle, increased R value, and decreased CI and MA value (P<0.05). With increase of SOFA scores, R value and K value increased significantly, and α angle, MA value, and CI decreased significantly (P<0.05). According to TEG, platelet function and fibrinogen function of DIC patients were significantly reduced, and the body showed hypocoagulability. (PMID: 30988714)
Treatments
- Basically don't get it.
- Treat underlying condition
- Treatment is lousy. Evidence behind treatment is likewise lousy.
- Platelets, cryo, FFP
Mortality
- 20-50%