Disseminated Intravascular Coagulation

Front 1

Disseminated Intravascular Coagulation (DIC)

Back 1

- tissue factor activates coagulation
- fibrin deposits cause plt activation depleting plts, fibrinogen, and other factors-->bleeding
- in response to coagulation, plaminogen activators and free plasmin degrade fibrinogen and fibrin, alpha-2 antiplamin is depleted
- FDPs accumulate which interferes w/ plt aggregation, fibrin polymerization, thrombin activity, and cause hemolytic anemia

Front 2

Tissue factor

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- tissue thromboplastin
1.) In granules of promyelocyte leukemic cells
2.) Endothelia cell disruption
3.) Cytokines and endotoxins induce endothelial cell to upregulate tissue factor activity and down regulate thrombomodulin
4.) Adenocarcinoma express tissue factor on the cell surface
5.) in brain, lung, placental tissue

Front 3

Lab diagnosis of DIC

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1.) increased PT and PTT
2.) decreased plts
3.) increased FDPs
4.) increased D-dimers
5.) decreased fibrinogen
6.) positive protamine sulfate test

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PT and PTT in DIC

Back 4

increased

Front 5

plts in DIC

Back 5

decreased

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FDPs in DIC

Back 6

increased

Front 7

D-dimers in DIC

Back 7

increased

Front 8

fibrinogen in DIC

Back 8

decreased

Front 9

protamine sulfate test in DIC

Back 9

positive

Front 10

Dilute Russel Viper Venom

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venom to detect lupus anticoagulant, not sensitive to heparin

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Differential diagnosis of DIC

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1.) Liver disease
2.) Primary fibrinolysis
3.) TTP

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Treatment

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- treat underlying disease

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Treatment of bleeding due to consumption of clotting factors and plts

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1.) Cryoprecipitate - fibrinogen
2.) Plts (stabile factor in plasma) if count is >50,000 plt function impaired due to FDPs
3.) FFP - factor replacement (including anticoagulants)

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Treatment of non-bleeding patients (thrombosis)

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1.) anticoagulants
2.) anti-fibrinolytics
3.) antithrombin 3
4.) gabexate, tissue factor inhibitor, or activated protein C

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Anticoagulants

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- treatment of thrombosis
- stop coagulation
- heparin has limited value except in chronic DIC of malignancy
- good inhibition of thromboembolism, of some use in acute promyelocytic leukemia
- trans-retinoic acid: differential therapy for promyelocytic leukemia

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Anti-fibrinolytics

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- epsilon-aminocaproic acid (EACA)
- inhibits fibrin dissolution, limited value may cause thromboembolytic complications
- works best in promyelocytic leukemia

Front 17

Antithrombin III

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- inhibits coagulation and break the DIC chain, but has limited success