DIC课件.pptVIP

Disseminated Intravascular Coagulation Du Xin（杜新） Dept. of Hematology The First Affiliated Hospital of SZU 1. What’s DIC ? DIC is an acquired syndrome characterized by : intravascular activation of coagulation deposition of fibrin within the microvasculature. 2. What’s DIC ? Consequences of DIC: Organ ischemia and infarction due to thrombosis Consumption of clotting factors and platelets Hemorrhagic diathesis and clinical bleeding 1. Causes of DIC Infections G– or G+ septicemia (endotoxin) Viruses (e.g. EBV, MCV, HIV) Miliary TB Fungi Parasites (malaria, Toxoplasma spp.) 2. Causes of DIC Release of Tissue Factor (TF) Disseminated malignancies Obstetric accidents: Preeclampsia, placental abruption, amniotic fluid embolism Extensive trauma, burns, surgery Aortic aneurysm Transfusion reaction 1. Pathophysiology of DIC (Acute) Thrombosis Extensive exposure to TF Profound activation of coagulation Thrombin promoted platelet activation Consumption of Antithrombin/TM/PC/PS Depressed fibrinolysis due to PAI-1 over production by inflammation Microangiopathic hemolysis Partially occluded vessels Macrophage activation 2. Pathophysiology of DIC (Acute) Dysfunction of coagulation Rapid consumption of FV/FVIII/Fibrinogen/platelets Increased fibrinolysis due to FDP enhance activity of t-PA Persistent oozing Microcirculation disturbance 3. Pathophysiology of DIC (Chronic) Rate of production Rate of consumption for fibrinogen and FVIII Ongoing consumption of coagulation inhibitors and Plasminogen and t-PA Shifts hemostatic balance towards thrombosis 1. Clinical Presentation Acute DIC occurs with Endotoxemia Extensive tissue trauma Preeclampsia Placental abruption Amniotic fluid embolism Hypotension or shock for any reason Difficult surgical procedure Massive stroke Heart attack 2. Clinical Presentation Chronic DIC occurs with Malignancies Old age Male Advanced cancer and necrosis Adenocarcinomas of lung, breast, prostate, colorectum Aortic aneurysms Large h