DIC
Revision as of 22:57, 21 October 2022 by Aesetholephews (talk | contribs) (→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
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)
Treatments
- Basically don't get it.
- Treat underlying condition
- Treatment is lousy. Evidence behind treatment is likewise lousy.
- Platelets, cryo, FFP
Mortality
- 20-50%