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    DIC

    Uploaded by

    Shizra Farrukh
    Disseminated intravascular coagulation

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    DIC

    Uploaded by

    Shizra Farrukh
    16 views20 pages
    Disseminated intravascular coagulation

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    DIC ppt

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    Disseminated intravascular coagulation

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    16 views20 pages

    DIC

    Uploaded by

    Shizra Farrukh
    Disseminated intravascular coagulation

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Disseminated

    Intravascular
    Coagulation (DIC)
    Dr Muhammad Javed Asif
    • DIC is also designated as
    Acquired Consumptive
    Coagulopathy
    Definition
    An acquired syndrome characterized by

    • Intravascular activation of coagulation with loss of


    localization.

    • Arises from different causes.


    DIC
    6
    • Systemic intravascular
    coagulation Thrombosis

    • Coagulation is always Platelet


    the initial event. Red Blood Cell

    • Severity depends on
    extent of intravascular Fibrin
    thrombosis
    Etiology
     Sepsis/ Severe infections:
     Trauma:
     Organ destruction:
    - Severe pancreatitis
     Malignancies:
    • Solid Tumors
    • Leukaemias,
    *Acute Promyelocytic ( AML-M3) /APML.
    • Lymphoproliferative disorders
    • Myeloproliferative syndromes
    Etiology
    Obstetrical Causes:
    • Amniotic fluid embolism
    • Abruptio placenta (premature separation of placenta)
    • Septic abortion
    • Retained products of conception
    • HELLP syndrome (Haemolysis Elevated Liver enzymes & Low
    Platelets)
    Severe toxic or immunological reactions:
    • Snake bites
    • Transfusion reactions
    • Transplant rejection
    • drugs
    Etiology
    Massive blood loss with inadequate fluid
    replacement therapy
    Severe hepatic failure
    Vascular abnormalities
    Severe burns
    Pathophysiology of DIC
    1. Activation of Blood Coagulation
    2. Suppression of Physiologic Anticoagulant Pathways
    3. Impaired Fibrinolysis
    4. Cytokines
    Pathophysiology
    of DIC

    1. Activation of Blood Coagulation


    • Tissue factor/factor VII a mediated thrombin generation via the extrinsic
    pathway
    • Activates factor IX and X
    • TF can be generated by;
    • endothelial cells
    • monocytes
    • Extravascular:
    • lung
    • kidney
    • epithelial cells
    Pathophysiology
    of DIC

    2. Suppression of Physiologic Anticoagulant Pathways


    • Reduced antithrombin III levels
    • Reduced activity of the protein C-protein S system
    • Insufficient down regulation of tissue factor activity by Tissue
    Factor Pathway Inhibitor (TFPI)*

    *TFPI inhibits TF/FVIIa/Fxa complex activity


    Pathophysiology
    of DIC

    3. Impaired Fibrinolysis
    • relatively suppressed at time of maximal
    activation of coagulation due to increased
    Plasminogen Activator Inhibitor Type 1
    Pathophysiology of
    DIC

    4. Cytokines ( IL-1, IL-6, IL-10 & TNF- )


    • IL-6, and IL-1 mediates coagulation activation in DIC
    • TNF-
    • mediates dysregulation of physiologic anticoagulant pathways and
    fibrinolysis
    • modulates IL-6 activity
    • IL-10 may modulate the activation of coagulation.

    Inflamation Coagulation
    DIC

    SYSTEMIC ACTIVATION OF
    COAGULATION

    Intravascular Depletion of platelets


    deposition of fibrin and coagulation
    factors

    Thrombosis of small and Bleeding


    midsize vessels

    Multiple Organ failure DEATH


    Investigations
    • CBC
    • Anaemia (variable)
    • Platelet count ?
    • Peripheral Smear ?
    • Coagulation Profile
    • PT ?
    • APTT ?
    • Serum Fibrinogen ?
    • Fibrinogen degradation products ( FDP’s) ?
    • D-Dimers ?
    Investigations
    • CBC
    • Anaemia (variable)
    • Platelet count (decreased)
    • Peripheral Smear (RBC fragmentation)
    • Coagulation Profile
    • PT (prolonged)
    • APTT (prolonged)
    • Serum Fibrinogen (depletion)
    • Fibrinogen degradation products (FDP’s) (increased)
    • D-Dimers (increased)
    Microscopic findings in
    DIC
    • Fragments
    (Schistocytes)

    • Paucity of
    platelets
    Schistiocytes

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