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27 Cards in this Set
- Front
- Back
Basic description of DIC |
Overstimulation of the clotting cascade - then the clotting factors are all used up - then the bleeding starts
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How long does it take a normal clot to lyse?
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7-10 days
In DIC, clot lyses right away as soon as its made |
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What is the end result of a clot lysing
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Split fibrin products
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How do split fibrin products contribute to bleeding?
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They are anticoagulant
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Intrinsic causes of DIC |
ARDS, hypoperfusion, sepsis
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Fibrinogen trends in DIC
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Decreased, because used up to make clots
Fibrinogen is converted to fibrin to make a clot |
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PT/PTT trends in DIC
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Increased - because taking longer to clot as blood becomes more anticoagulated
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D-dimer trends in DIC
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Increases - it is essentially a fibrin split product
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Platelets and DIC |
Thrombocytopenia because get used up in microclots, same as the clotting factors
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PT in DIC
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>40 sec
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aPTT in DIC |
>70 sec
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Thrombin time
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>15 sec
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Fibrinogen level
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Less than 200
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Clotting factor depletion |
I, V, VIII low, consider them the limiting reagents
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Heparin use for DIC
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Used when other treatments fail
Prevents clotting in the microvasculature - which is the biggest problem in DIC, not hemorrhage |
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Contraindications to heparin in DIC
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Hemorrhage, hepatic failure DIC, recent surgical procedures
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Antithrombin III
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Inhibits the action of thrombin
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FFP
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Contains all clotting factors
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Cryoprecipitate
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Factors VIII, XIII and fibrinogen
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Desmopressin
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Improves platelet function when platelet dysfunction is caused by aspirin or NSAIDs
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Vitamin K
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Needed for liver production of clotting factors - won't do any good if liver is shot
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Heparin action according to Gasparis
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Prevents the conversion of prothrombin to thrombin
Inactivates existing thrombin Prevents conversion of fibrinogen to fibrin |
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Why not give clotting factors before heparin?
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The body will make immediate clots that will immediately lyse
Have to stop the clotting first, and then address the lysing |
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HIT
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Anti-thrombin III not present, so heparin causes blood to clot instead of anticoagulating
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Anticoagulant used for HIT positive people
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Argatroban
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T cells vs B cells
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T cells - army - looks for viruses and non-self in the tissue
B cells - navy - looks for foreigns in the blood |
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Therapeutic heparin drip indicators
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When aPTT is 1.5-2 normal aPTT
About 25 seconds |