內科學：Disseminated Intravascular Coagulatoin(DIC)

1、Disseminated Intravascular Coagulatoin(DIC)General DIC is a pathologic process and clinical syndrome arising from a heterogeneous group of medical disorders. Pathologic features: the activation of coagulation(thrombin凝血酶) ,thrombosis ; the consumption of hemostatic components; the secondary fibrinol

2、ysis(plasmin纖溶酶) Clinical feature:hemorrhagic and thrombotic complicationsDefinition(ISTH) DIC is an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes.It can originate from and cause damage to the microvasculature,w

3、hich if sufficiently severe,can produce organ dysfuction.Common Causes Infection感染:bacteria,viruses,fungi,Rickettsia, cerebral malaria Malignancy腫瘤: solid tumor,leukemia,lymphoma Obstetric complications 產(chǎn)科意外: abruptio placentae,amniotic fluid embolism,septic abotion,dead fetus syndrome,eclampsia Tis

4、sue injury組織損傷: extensive trauma, burns, operatoin, heat stroke Other causes: serious diseases of various systems,ABC incompatible blood transfusoin, snake envenomation,hemangiomasPathogenesis Tissue factor(TF組織因子) TF. aTenase complexprothrombinase complexthrombinfibrin formation, platelets aggregat

5、ion, plasmin The failure of coagulation inhibitory mechanismsPathology and Pathophysiology Microvascular thrombosis血栓(fibrin or fibrin-platelet thrombi) Abnormality of coagulatoin function凝血功能異常(hypercoagulating stageconsumptive hypocoagulating stagesecondary fibrinolysis) Disfunction of microcircul

6、ation(MOF)Clinical Features Bleeding出血: petechiae,ecchymoses,oozing from venipucture sites and cathters,internal hemorrhage Shock休克 Microvascular thromboembolia血栓栓塞 Microangiopathic hemolysis溶血 Clinical features associated with the primary iniciating illness Laboratory Features Platelet count 血小板 Fi

7、brinogen level 纖維蛋白原 Prothrobin time(PT) 凝血酶原時間 3P test ,D-dimer,FDP level 纖溶指標 Thrombin time(TT) Partial thromboplastin time(APTT) AT- level,plasminogen level,F:C activity Fragmented RBC examination and countDiagnosisThere are primary iniciating diseasesTwo or more than two kinds of clinical manife

8、station:bleeding; shock; thromboembolism; effective to anticoagulant therapyThree or more than three abnormal laboratory findings 國際血栓止血學會DIC診斷標準 1風險評估：病人是否存在與典型DIC發(fā)病 有關的潛在疾??？是進入程序否退出凝血指標檢測血小板計數(shù) 纖維蛋白相關標志（可溶性纖維蛋白單體FDPs） PT 纖維蛋白原水平3凝血指標檢測結果與積分 血小板計數(shù)(109/L)： 100=0 100=1 50=2 可溶性纖維蛋白單體FDPs： 無增加=0 中度增加=2

9、 顯著增加=3 PT延長 3s,6s=2纖維蛋白原水平: 1.0g/L=0 1.0g/L=1 4積分累計 結果判斷 5分 典型DIC, 每天重復積分 5分 非典型DIC, 其后12天重復 積分Differential Diagnosis1. The coagulopathy of liver disease2. Thrombotic thrombocytopenic purpura(TTP) Triad（三聯(lián)征）: microangiopathic hemolytic anemia; thrombocytopenic purpura; neurologic symptoms Pentad（五聯(lián)征）: triadfever renal dysfuction 3. Primary fibriogenolysisTreatment1.Treatment of underlying disorders and supportive care 去因2.Replacement therapy 替代3.Anticoagulant therapy 抗凝 Heparin is important,b