堇腬敄慰瑲敭瑮漠慐桴汯杯-Disseminated.pptVIP

Bachelor of Chinese Medicine Disseminated intravascular coagulation (DIC) Dr. Edmond S. K. Ma Division of Haematology Department of Pathology The University of Hong Kong Disseminated intravascular coagulation Systemic thrombo-haemorrhagic disorder Characteristic features: activation of coagulation system activation of fibrinolytic system consumption of clotting factors consumption of natural inhibitors thrombocytopenia Disseminated intravascular coagulation: characteristics Widespread activation of coagulation ? intravascular formation of fibrin ? thrombotic occlusion of small vessels ? contributes to multiple organ failure in conjunction with haemodynamic and metabolic consequences Depletion of platelets and clotting factors ? severe bleeding Skin Bruises Associated Clinical Conditions Sepsis Trauma Serious tissue injury Fat embolism Cancer Obstetrical complications Vascular Giant haemangioma Aortic aneurysm Reaction to toxins Immunological disorders Haemolytic transfusion reaction Transplant rejection DIC and Infectious Disease Severe sepsis is the most common clinical condition associated with DIC Bacterial infection Occurs in 30 - 50% of Gram -ve sepsis Lipopolysaccharide (endotoxin) Gram positive sepsis exotoxin (e.g. staphylococcal a-haemolysin) DIC and severe trauma Especially seen after brain trauma release of fat and phospholipid Cytokine activation similar pattern to severe sepsis “Systemic inflammatory response syndrome” after trauma 50 - 70% associated with DIC DIC and Cancer Solid tumours metastatic cancer 10 - 15% Haematological cancer acute leukaemia 15% ‘Cancer pro-coagulant’: tissue factor Acute promyelocytic leukaemia DIC and hyperfibrinolytic state DIC and Obstetrical Disorders Abruptio placentae, amniotic fluid embolism, fetal death in utero, septic abortion 50% of cases Release of thromboplastin-like material Usually short-lived and self-limiting Pre-eclampsia (7%) DIC and Giant Haemangioma Local activation of coagulation system ? syste