Haem - DIC

Question 1

What is DIC

Answer 1

An acquired syndrome
Characterised by intravascular activation of coagulation With loss of localisation from different causes.
Can originate from and cause severe damage to microvasculature Which if severe can produce organ dysfunction OR Dysregulated host response to triggers

Question 2

Triggers for DIC

Answer 2

Sepsis
Trauma - burns and rhabdo
Obstetrics - AFE, placental abruption, pre-eclampsia, PPH

Question 3

Pathology of DIC

Answer 3

excess thrombin generation
increased thrombogenesis occurs with increased fibrinolysis
Simultaneous thrombosis AND bleeding
Normally - thrombin is both pro and anticoagulant.
Severe trigger - excess thrombin —> overwhelemd regulatory processes
No more localisation and disseminates systemically.
Fibrinolytic path tries to counteract clot formation, large volume of fibrin degradation products

Question 4

Features of DIC

Answer 4

Bleeding and thrombis releated
Bleeding - Skin is first manifestiation —> echymoses, petechiae Bleeding from skin punctures Mucosal bleeding —> hyperfibrinolysis -
GI bleeds

Thrombosis - 	AKI	Hepatic dysfunction	Resp - alveolar haemorrhage, ARDS	CNS - vessel occlusion, SAH, haemorrhages and infarcts

Question 5

Diagnosis of DIC

Answer 5

ISTH Score >5
TEG/ROTEM —> early —> hypercoagulable start (short R, increased an angle, increased MA, high lysis.
late —> hypocoag —> prolonged R, reduced a, low MA

Question 6

Features of the ISTH score

Answer 6

Underlying pre-disposing condition —> essential
Plt Count
FDP/D Dimer
Fibrinogen <1
PT prolonged

Question 7

Managment of DIC

Answer 7

ABCDE etc
Treat underlying cause
1) blood products - RBC aim Hb>90 is acutely bleeding FFP if INR>1.5 or APTT ratio > 1.5 Plts if <50 Cryo (2 pools) OR fibrinogen conc if fibrinogen <1
2) thromboprophylaxis If risk of bleed high (unfractionated heparin)AVOID TXA —> inhibiting fibrinolysis may make things worse