Disseminated intravascular
coagulopathy
It is a disorder arising as a
secondary manifestation of various diseases where there are consumption of platelets,
clotting factors in wide spread area of circulation as well as secondary
activation of plasminogen fibrinolytic system.
Etiology:
1.
Massive tissue trauma
2.
Sepsis
3.
Obstructive complications: abruption placenta,
Dead fetus, amniotic fluid embolism
4.
Incompatible blood transfusion
5.
Fat embolism
6.
Cardio pulmonary bypass surgery
7.
Advance malignancy
8.
Autoimmune diseases
9.
Shock, heatstroke ,burn
10.
Snake venom
Sites: in decreasing order of
frequency
1.
Brain
2.
Heart
3.
Lungs
4.
Kidneys
5.
Adrenal glands
6.
Spleen
7.
Liver
Pathophysiology:
Wide spread activation of the
inflammatory
Cells due to the predisposing
Factor
Causes release of cytokines (IL-1,
6, 8, TNF, Plasminogen
Activator factor, amino acid
metabolites)
↓
When there is large amount of
cytokines released
Its causes endothelial damage and
cytokines
Exposed to sub endothelial matrix
↓
at the same time it causes
activation of both arm
of coagulation pathway (intrinsic
& extrinsic) in
wide spread area of the body.
↓
Formation of micro thrombi
↓
(A.)Vascular occlusion of various
organ-
1. microangiopathic hemolytic
anemia(due to fragmentation of red cell )
2. Ischemic tissue damage
(B.)Activision of plasmin
1.
Proteolysis of clotting factors
2.
Fibrinolysis- inhabit thrombin, platelet
aggregations, fibrin polymerization
Consumption of clotting factors and platelet ;hence
it also called CONSUMPTION COAGULOPATHY
NOTE:
The predisposing factors are often
multiple and interrelated
TWO MAJOR MECHANISM TRIGGERED DIC:
1.
Release of tissue factors or thromboplastic
substances into the
Circulation
2.
Wide spread injury to the endothelial cell
TWO CONSEQUENCES OF DIC:
1.
Widespread deposition of fibrin within the
microcirculation
Leads to ischemia
2.
Consumption of platelet and clotting factors and
the activation of
Plasminogen leads to hemorrhagic diathesis.
As there is consumption of platelet so there is increase of BLEEDING TIME
& PT
As
there is consumption of clotting factors so there is increase of CLOTTING TIME
&
