兽医病理生理学课件 9-弥散性血管内凝血DIC.ppt

微血管病性溶血性贫血（Microangiopathic Hemolytic Anemia）:慢性DIC和有些亚急性DIC常出现hemolytic anemia的症状，外周血涂片可发现新月形、盔甲形、星形、三角形等变形红细胞，被称为裂体细胞（schistocyte）。 在DIC发病过程中，fibrin除形成microthrombus外，也有相互交织联结在微血管中形成纤维蛋白丝、纤维蛋白网，特别在DIC早期小血管中这些纤维蛋白丝网较多。当红细胞随血流快速在微血管中流动时，被纤维蛋白丝网撞击、粘挂，或红细胞嵌在VEC较大裂隙处。血流冲击使这些红细胞受到挤压、切割等机械损伤，最终红细胞变形、破裂形成schistocyte。 Schistocyte变形能力显著降低，脆性增高，在血流的冲击、碰撞下容易破裂，发生溶血。将这种因微血管发生病理变化而导致红细胞破裂引起的贫血，称为microangiopathic hemolytic anemia。外周血涂片中发现较多schistocyte（超过红细胞数2%），虽非DIC所特有，却是诊断DIC的重要参考指标。 Microangiopathic hemolytic anemias comprise thrombocytopenic thrombotic purpura, the hemolytic–uremic syndrome, chemotherapy-induced microangiopathic hemolytic anemia, malignant hypertension, and the HELLP syndrome (hemolysis, elevated liver-enzyme levels, and a low platelet count occurring in association with preeclampsia).20 Although some characteristics of microangiopathic hemolytic anemias and the resulting thrombotic occlusion of small and midsize vessels may mimic the clinical picture of disseminated intravascular coagulation, these disorders are a distinct group of diseases. The common feature of the microangiopathic hemolytic anemias appears to be endothelial damage, which causes the adhesion and aggregation of platelets, the formation of thrombin, and the impairment of fibrinolysis. In patients with thrombocytopenic thrombotic purpura and the hemolytic–uremic syndrome, the acquired deficiency of a protease that cleaves multimers of von Willebrand factor leads to the accumulation of large multimers of this factor.21 A cardinal sign of microangiopathic hemolytic anemia is the presence of fragmented red cells (schistocytes) in the blood smear. Although hemolytic anemia and schistocytes are also sometimes present in patients with severe disseminated intravascular coagulation (because of the presence of intravascular fibrin), these are invariable findings in patients with microangiopathic hemolytic anemia. 外源性凝血系统: 15 seconds;内源性凝血系统, 1-6 min Clotting factors from livers: I, II, V, VII, IX,