DI--幻灯片.pptVIP

diagnosis and management of ----  Disseminated Intravascular Coagulation DIC a clinicopathological syndrome which complicates a range of illnesses. characterised by systemic activation of pathways leading to and regulating coagulation, which can result in the generation of fibrin clots that may cause organ failure with concomitant consumption of platelets and coagulation factors that may result in clinical bleeding Associations sepsis, malignancy, trauma, liver disease and vascular anomalies. pregnancy (by placental abruption or amniotic fluid embolism complicate poisoning, envenomation major transfusion reactions Clinical manifestation hemorrhagic tendency circulatory failure or shock embolism in micrangium microangiopathic hemolytic anemia Pathogenesis Enhanced generation of thrombin in vivo increased tissue factor expression suboptimal function of natural anticoagulant systems dysregulation of fibrinolysis Diagnosis of DIC Pre-DIC Recognition of underlying condition associated with DIC Symptom which can’t be explain by primary disease increased level of F1+2、TAT in plasma Diagnosis of DIC Platelet count (not very specific) -reduction in the platelet count or a clear downward trend (100 *109/l) -a continuous drop even within a normal range may indicate the active generation of thrombin. -a stable platelet count suggests that thrombin formation has stopped PT and APTT -Prolonged in about 50–60% of cases of DIC ---prolonged PT3s ---prolonged APTT10s -Half of patients of DIC, the PT and APTT are normal or even shortened because of the presence of circulating activated clotting factors -repeat monitoring is required. Fibrin degradation products and D-dimer - FDP10 mg/L 60 mg/L (in liver disease) - D-dimer 0.46 mg/L FDP do not discriminate between degradation products of cross-linked fibrin and fibrinogen degradation,