DIC Flashcards
What is DIC?
- acquired syndrome characterised by activation of coagulation pathways
- resulting in formation of intravascular thrombi and depletion of platelets and coagulation factors
What are RF for DIC?
- Major trauma/burn/organ destruction or sepsis/severe infection
- Severe obstetric disorders of complications
- Solid tumour and haematological malignancies
- Severe toxic or immunological reactions
What is needed for DIC to be considered?
underlying disorder is required for consideration of disseminated intravascular coagulation (DIC)
What are the signs and symptoms of DIC?
- Oliguria, hypotension or tachycardia
- Purpura fulminans, gangrene or acral cyanosis
- Delirium or coma
- Petechiae, ecchymosis, oozing or haematuria
What are possible DDx of DIC?
- Severe liver failure
- Heparin-induced thrombocytopenia
- Idiopathic purpura fulminans
- Vit K def
- HELLP syndrome
What investigations are for DIC?
- Platelet count
- PT
- Fibrinogen
- D dimer
- aPTTT
- blood film
- Haemoglobin (low)
- High fibrin products
What is the platelet count like in DIC?
decreased
What is PT like in DIC?
prolonged
What is fibrinogen levels like in DIC?
decreased
What is d-dimer levels like in DIC?
elevated
What are aPTT levels like in DIC?
prolonged in 50-60% patients
What does blood film for DIC show?
broken RBC (schistocytes)
What is the treatment of acute DIC?
- 1st line: treatment of underlying disorder
- Plus: platelets + coagulation factors and coagulation inhibitors
- Score >5 compatible overt DIC
What is the treatment for ongoing DIC?
- 1st line: treatment of the underlying disorder
- If dominate thrombotic signs: heparin as well
- If underlying hyperfibrinolysis: antifibrinolytic agents
What are possible complications of DIC?
- Acute renal failure
- Life-threatening haemorrhage
- Cardiac tamponade, haemothorax, intracerebral haematoma
- Gangrene and loss of digits
What is prognosis of DIC like?
high mortality
What is the pathophysiology of DIC?
- some underlying condition which causes the generalised activation of the clotting cascade
- so clotting takes place in different parts of body even where it is not needed
3, platelets and clotting factors being used up this process rapidly so vulnerability to bleeding as well - lots of fibrin being produced which gets into blood vessels which slices up rbc causing microangioapathic hamolytic anaemia
What anaemia results from DIC?
microangioapathic heamolytic anaemia
What is acute overt DIC?
- Emergency and life threatening
2. Significant platelet and clotting factor depletion leads to bleeding
What is chronic non-overt DIC?
- Slower rate with time for compensatory response
2. Hypercoagulable state but less bleeding
What sort of issues does acute overt DIC show up with?
bleeding issues
What sort of issues does chronic non-overt DIC show up with?
clotting issues
What are the symptom and signs of acute DIC?
- Petechiae
- Purpura
- Ecchymosis
- Epistaxis
- Respiratory distress
What are the symptoms and signs of chronic DIC?
- Signs of DVT
2. Arterial thrombosis
What does blood film show in DIC?
schistocytes (broken RBC)
What are bleeding features for DIC?
- Petechiae
- Ecchymoes
- Haematuria
What are clotting features of DIC?
- Prolonged APTT
2. Prolonged PT
What are the haemolytic features of DIC?
- Jaundice
2. Conjunctival pallor
What is DIC related to?
ITU
