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    Perdarahan: DR - Suhaemi, SPPD, Finasim

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    Disseminated intravascular coagulation (DIC) is characterized by the systemic activation of the coagulation system followed by activation of the fibrinolytic system, resulting in high thrombin and plasmin generation. DIC is not a disease itself but rather a manifestation of an underlying serious disorder. Activation of coagulation leads to microthrombi formation and consumption of platelets and clotting factors. This is followed by secondary activation of fibrinolysis, resulting in a thrombotic and hemorrhagic clinical picture. Common causes of DIC include infection, malignancy, obstetric complications, trauma, and surgery.

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    Perdarahan: DR - Suhaemi, SPPD, Finasim

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    19 views27 pages
    Disseminated intravascular coagulation (DIC) is characterized by the systemic activation of the coagulation system followed by activation of the fibrinolytic system, resulting in high thrombin and plasmin generation. DIC is not a disease itself but rather a manifestation of an underlying serious disorder. Activation of coagulation leads to microthrombi formation and consumption of platelets and clotting factors. This is followed by secondary activation of fibrinolysis, resulting in a thrombotic and hemorrhagic clinical picture. Common causes of DIC include infection, malignancy, obstetric complications, trauma, and surgery.

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    Disseminated intravascular coagulation (DIC) is characterized by the systemic activation of the coagulation system followed by activation of the fibrinolytic system, resulting in high thrombin and plasmin generation. DIC is not a disease itself but rather a manifestation of an underlying serious disorder. Activation of coagulation leads to microthrombi formation and consumption of platelets and clotting factors. This is followed by secondary activation of fibrinolysis, resulting in a thrombotic and hemorrhagic clinical picture. Common causes of DIC include infection, malignancy, obstetric complications, trauma, and surgery.

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    19 views27 pages

    Perdarahan: DR - Suhaemi, SPPD, Finasim

    Uploaded by

    wie_wie_wie
    Disseminated intravascular coagulation (DIC) is characterized by the systemic activation of the coagulation system followed by activation of the fibrinolytic system, resulting in high thrombin and plasmin generation. DIC is not a disease itself but rather a manifestation of an underlying serious disorder. Activation of coagulation leads to microthrombi formation and consumption of platelets and clotting factors. This is followed by secondary activation of fibrinolysis, resulting in a thrombotic and hemorrhagic clinical picture. Common causes of DIC include infection, malignancy, obstetric complications, trauma, and surgery.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 27

    perdarahan

    Dr.suhaemi, SpPD, Finasim


    6.Disseminated Intravascular
    Coagulation (DIC)
    • DIC is characterized by
    – the systemic activation of the coagulation system
    followed by activation of fibrinolytic system
    – high thrombin and plasmin generation

    • DIC is not a disease itself, but is a


    manifestation of a serious underlying disorder.

    2
    Disseminated intravascular
    coagulation (DIC)
     secondary complication
    of some serious condition
     consumption coagulopathy

     thrombohemorrhagic diathesis

     acute, subacute, chronic


    Disseminated intravascular
    coagulation (DIC)

    activation of coagulation sequence

    microthrombi
    - consumption of platelets and clotting factors

    secondary
    activation of fibrinolysis
    DIC
    Thrombotic and hemorrhagic diathesis
    Consequences
    Microthrombi infarctions

    depletion of platelets and clotting factors

    + secondary activation of fibrinolysis

    hemorrhages
    Causes of DIC

    • Infection - bacterial sepsis, viral


    infections

    • Neoplasm - AML, adenocarcinoma

    • Obstetrical disorders - retained dead


    fetus, abruption, etc

    • Trauma/surgery - brain injury, crush, burns,


    etc.

    • Others - acute hemolytic


    transfusion reaction, etc.

    6
    Hemostatic Balance

    PAI-1 Prot. S

    Antiplasmin Prot. C

    Tissue factor* TFPI


    Fibrinolytic System
    Clotting Factors
    ATIII

    Procoagulant Anticoagulant

    7
    DIC
    SYSTEMIC
    • An acquired syndrome ACTIVATION OF
    COAGULATION
    characterized by
    systemic intravascular
    coagulation
    Intravascular Depletion of
    • Coagulation is always deposition of platelets and
    the initial event fibrin coagulation
    factors

    Thrombosis of
    small and Bleeding
    midsize vessels

    8 Organ failure DEATH


    Pathophysiology of DIC
    • Activation of Blood Coagulation
    – Tissue factor/factor VIIa mediated thrombin
    generation via the extrinsic pathway
    • complex activates factor IX and X
    – TF
    • endothelial cells
    • monocytes
    • Extravascular:
    – lung
    – kidney
    – epithelial cells

    9
    PATHOPHYSIOLOGIC
    Pathophysiology of DIC
    LABORATORY CLINICAL
    EVENTS MANIFESTATIONS MANIFESTATIONS

    underlying disorder

    depletion of clotting factors


    prolonged PT, PTT
    tissue factor release

    thromboctyopenia (consumption)
    activation of intrinsic hemorrhage
    pathway of coagulation
    (systemic thrombin
    depletion of physiologic anticoagulants
    generation)

    decreased fibrinogen

    generalized intravascular
    fibrin deposition microangiopathic hemolytic anemia

    thrombosis/infarction
    activation of
    fibrinolytic system
    (systemic plasmin increased FDP and D-dimer
    generation)

    10
    Laboratory Tests Used in DIC
    • D-dimer* • Thrombin time
    • Antithrombin III* • Fibrinogen
    • F. 1+2* • Prothrombin time
    • Fibrinopeptide A* • Activated PTT
    • Platelet factor 4* • Protamine test
    • Fibrin Degradation • Reptilase time
    Prod • Coagulation factor
    • Platelet count levels
    • Protamine test
    *Most reliable test

    11
    The main bleeding sickness types
    • Hematomic (massive, deep, painful; bleeding may occur anywhere.
    The most common sites of bleeding are into joints (knees, ankles, elbows),
    into muscles, from the gastrointestinal tract, cause of the bleeding can be
    intramuscular injection; characterized by early postoperative &
    posttraumatic bleeding)
    • hematoma
    • petechia-spotted
    (macula)
    macula-hematoma
    vasculitic purpura
    angioma
    Hemophilia
    Diagnostic
    criteria
    Hematomic
    bleeding sickness
    Arhtropathy
    types
    Thrombocytopenia

    Diagnostic
    criteria

    Petechial-
    ecchymosic 1. Deacrease
    of
    platelets
    Queen Victoria

    Carrier for Hemophilia


    Hemophilia is carried on the X chromosome

    Females X H X H normal
    X H X h carrier
    X h X h hemophiliac

    Males X H Y normal
    X h Y hemophiliac
    Hemophilic arthropathy

    “Target joint” = irreversibly damaged joint


    with vicious cycle of injury and repeated
    bleeding

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