Disseminated Intravascular Coagulation

Published on 27/03/2015 by admin

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Chapter 477 Disseminated Intravascular Coagulation

Thrombotic microangiopathy refers to a heterogeneous group of conditions, including disseminated intravascular coagulation (DIC), that result in consumption of clotting factors, platelets, and anticoagulant proteins. Consequences of this process include widespread intravascular deposition of fibrin, leading to tissue ischemia and necrosis, a generalized hemorrhagic state, and hemolytic anemia.

Etiology

Any life-threatening severe systemic disease associated with hypoxia, acidosis, tissue necrosis, shock, and/or endothelial damage may trigger DIC. A large number of conditions have been reported to be associated with DIC (Table 477-1). Although the clinical symptoms are more often hemorrhagic, the initiating event is usually excessive activation of clotting that consumes both the physiologic anticoagulants (protein C, protein S, and antithrombin III) and procoagulants, resulting in a deficiency of factor V, factor VIII, prothrombin, fibrinogen, and platelets. Commonly, the clinical result of this sequence of events is hemorrhage. The hemostatic dysregulation may also result in thromboses in the skin, kidneys, and other organs. Better understanding of the pathophysiology of hemostasis has lead to an appreciation of the critical interaction of the coagulation pathways with the innate immune system and inflammatory response that likely contributes to the widespread dysregulation present in DIC.

Table 477-1 CAUSES OF DISSEMINATED INTRAVASCULAR COAGULATION

INFECTIOUS

Meningococcemia (purpura fulminans)

Bacterial sepsis (staphylococcal, streptococcal, Escherichia coli, Salmonella)

Rickettsia (Rocky Mountain spotted fever)

Virus (cytomegalovirus, herpes simplex, hemorrhagic fevers)

Malaria

Fungus

TISSUE INJURY

Central nervous system trauma (massive head injury)

Multiple fractures with fat emboli

Crush injury

Profound shock or asphyxia

Hypothermia or hyperthermia

Massive burns

MALIGNANCY

Acute promyelocytic leukemia

Acute monoblastic or promyelocytic leukemia

Widespread malignancies (neuroblastoma)

VENOM OR TOXIN

Snake bites

Insect bites

MICROANGIOPATHIC DISORDERS

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