各论1精品教学（浙江大学）16血液循环障碍DIC2.pptVIP

Coagulation Disorders and Disseminated Intravascular Coagulation (DIC) Normal Hemostasis Hemostasis Initiation of coagulation Coagulation Pathways Normal Hemostasis Normal Hemostasis Normal Hemostasis Normal Hemostasis Normal Hemostasis Normal Hemostasis Normal Hemostasis Normal Hemostasis:  Pivotal role of TF/VIIa Platelet Activation Pathways Disseminated Intravascular Coagulation (DIC) DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment -Xigris Primarily a thrombotic process Systemic process producing both thrombosis and hemorrhage Also called consumption coagulopathy and defibrination syndrome1 Its clinical manifestation may be widespread hemorrhage in acute, fulminant cases2. DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment Basic pathophysiology Entry into the circulation of procoagulant substances Trigger systemic activation of the coagulation system and platelets Lead to the disseminated deposition of fibrin-platelet thrombi. Procoagulant stimulus is tissue factor (most cases) Lipoprotein Not normally exposed to blood. Tissue factor gains access to blood by Tissue injury, Malignant cells, Expression on the surfaces of monocytes and endothelial cells by inflammatory mediators. DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment Tissue factor triggers Thrombin Protease Induces fibrin formation and platelet activation Other procoagulants Cysteine protease Mucin（粘液素） Trypsin DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment Acute DIC Coagulation factors are consumed at a rate in excess of the capacity of the liver to synthesize them, Platelets are consumed in excess of the capacity of bone marrow megakaryocytes to release them. DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment Laboratory manifestations Prolonged prothrombin time (PT) Prolonged Activate