DIC In Pregnancy

Question 1

What are the obstetric specific causes of DIC ?

Answer 1

1- abruption
2- PET
3- amniotic fluid embolism
4- HELLP
5- IUFD
6- septic abortion
7- PPH

Question 2

What are the 2 types of DIC ?

Answer 2

• acute
• chronic ( in malignancy)

Question 3

What are the clinical features of DIC?

Answer 3

1- chest pain / dyspnoea
2- leg pain
3- neurological symptoms
4- bleeding: hematourea- skin blood in the stool - vaginal- site of operation

Question 4

What are the laboratory findings in DIC ?

Answer 4

• pt- ptt ⬆️
• D-dimer ⬆️
  *fibrinogen degradation products⬆️
• plt ⬇️
• fibrinogen ⬇️
  Peripheral blood: fragments RBCs
  ( not specific not sensitive)

Question 5

What is the role of heparin in DIC?

Answer 5

Can be used in chronic DIC

Question 6

What is the main treatment for DIC?

Answer 6

1-Fresh frozen plasma 👉correct pt- ptt
2- cryoprecipitate 👉 correct fibrinogen
3- platelets 👉 correct plt

Question 7

In what circumstances should FFP be used?

Answer 7

FFP should be administered at a dose of 12 - 15 ml / kg for every 6 units of red cells
Subsequent transfusion should be guided by the tests results:
PT / APTT at less than 1.5 normal
[ compatible ABO group]

Question 8

In what circumstances should cryoprecipitate be used?

Answer 8

*Standard dose two ( 5-unit) pools early in major obstetric haemorrhage
* subsequent transfusion should be guided by fibrinogen results
The aim : > 1.5 g/ L
[ compatible ABO group]

Question 9

If RhD- negative woman receives RhD positive FFP or cryoprecipitate what is the management?

Answer 9

NO anti-D prophylaxis is required

Question 10

When should platelets be used in DIC?

Answer 10

Maintain plt > 50 × 10⁹ in acutely bleeding patient
* platelet transfusion trigger of 75 × 10⁹ is recommended
[ compatible RhD group]