Disseminated Intravascular Coagulation

Question 1

Describe the 4 functions/roles of thrombin

Answer 1

1. Pro-coagulant- (activates factor V, VII, and IX)
2. Anti-coagulant (activates Protein C and Protein s)
3. Pro-Fibrinolytic(activates tPA)
4. Antifibrinolytic(Activates TAFI)

Question 2

What are the two symptoms that could possibly indicate DIC?

Answer 2

1. Thrombosis- due to excessive thrombin production.
2. Bleeding- as a result of depletion of platelets, consumption of coagulation factors and accelerated PLASMIN formation

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Question 3

Discuss the Aetiology of Disseminated Intravascular Coagulation.

Just 5 causes

Answer 3

1. SEPTICAEMIA (GN lipo and GP exotoxin induce expression of TF on monocytes and neutophils)
2. Obstetric Complications( Amniotic Fluid and Placenta are rich sources of TF…in complications they would be released into the maternal blood stream)
3. Excessive Tissue Damage (major surgery, burns, injury…)
4. Cancer(eg. Acute Promyelocytic Leukemia)
5. **Direct Activation of Factor X(10) or Prothrombin (eg, snake venoms)

Question 4

Discuss the clinical manifestations of DIC

there’s 4 of them

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Answer 4

1. Hypotension and Shock
2. Bleeding (eg), Purpura, petechiae
3. Multi-Organ Dysfunction
4. Altered Mental State

Question 5

Describe the Clinical Manifestations of Chronic DIC.

Answer 5

No SHOCK IS OFTEN PRESENT

In chronic DIC, there’s exposure to smaller amounts of thrombin for prolonged periods.

Question 6

Describe the LAB diagnosis of DIC

Answer 6

prolonged PTT and INR

1. Decreased platelet count(less than 50x10^9 platelets/litre)
2. Decreased Haem Level
3. Schistocytes
   (if there’s no platelet clumping that would indicate true thrombocytopenia)
4. Decreased **Fibrinogen **
5. Increased D-dimers
6. Increased urea and creatinine
7. Decreased Haptoglobin

Question 7

Describe the management of DIC

Answer 7

1. Treat the underlying disease and it will resolve on its own
2. Blood component therapy is reserved for those who are at high risk of bleeding.
3. If INR is less than 1.5, give fresh frozen plasma(FFP)
4. Give platelets if count is low
5. If Fibrinogen is less than 1g/L, give Cryoprecipitate (CRY-O-PRECIPITATE.
6. If Haematocrit (ratio of volume of RBC to blood volume) is less than 21%, give Packed Red Cells
7. Vitamin K
8. Treat Anticoagulation with UFH/LWHW in thrombosis