内科学：Disseminated Intravascular Coagulatoin(DIC)

1、Disseminated Intravascular Coagulatoin(DIC)General DIC is a pathologic process and clinical syndrome arising from a heterogeneous group of medical disorders. Pathologic features: the activation of coagulation(thrombin凝血酶) ,thrombosis ; the consumption of hemostatic components; the secondary fibrinol

2、ysis(plasmin纤溶酶) Clinical feature:hemorrhagic and thrombotic complicationsDefinition(ISTH) DIC is an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes.It can originate from and cause damage to the microvasculature,w

3、hich if sufficiently severe,can produce organ dysfuction.Common Causes Infection感染:bacteria,viruses,fungi,Rickettsia, cerebral malaria Malignancy肿瘤: solid tumor,leukemia,lymphoma Obstetric complications 产科意外: abruptio placentae,amniotic fluid embolism,septic abotion,dead fetus syndrome,eclampsia Tis

4、sue injury组织损伤: extensive trauma, burns, operatoin, heat stroke Other causes: serious diseases of various systems,ABC incompatible blood transfusoin, snake envenomation,hemangiomasPathogenesis Tissue factor(TF组织因子) TF. aTenase complexprothrombinase complexthrombinfibrin formation, platelets aggregat

5、ion, plasmin The failure of coagulation inhibitory mechanismsPathology and Pathophysiology Microvascular thrombosis血栓(fibrin or fibrin-platelet thrombi) Abnormality of coagulatoin function凝血功能异常(hypercoagulating stageconsumptive hypocoagulating stagesecondary fibrinolysis) Disfunction of microcircul

6、ation(MOF)Clinical Features Bleeding出血: petechiae,ecchymoses,oozing from venipucture sites and cathters,internal hemorrhage Shock休克 Microvascular thromboembolia血栓栓塞 Microangiopathic hemolysis溶血 Clinical features associated with the primary iniciating illness Laboratory Features Platelet count 血小板 Fi

7、brinogen level 纤维蛋白原 Prothrobin time(PT) 凝血酶原时间 3P test ,D-dimer,FDP level 纤溶指标 Thrombin time(TT) Partial thromboplastin time(APTT) AT- level,plasminogen level,F:C activity Fragmented RBC examination and countDiagnosisThere are primary iniciating diseasesTwo or more than two kinds of clinical manife

8、station:bleeding; shock; thromboembolism; effective to anticoagulant therapyThree or more than three abnormal laboratory findings 国际血栓止血学会DIC诊断标准 1风险评估：病人是否存在与典型DIC发病 有关的潜在疾病？是进入程序否退出凝血指标检测血小板计数 纤维蛋白相关标志（可溶性纤维蛋白单体FDPs） PT 纤维蛋白原水平3凝血指标检测结果与积分 血小板计数(109/L)： 100=0 100=1 50=2 可溶性纤维蛋白单体FDPs： 无增加=0 中度增加=2

9、 显著增加=3 PT延长 3s,6s=2纤维蛋白原水平: 1.0g/L=0 1.0g/L=1 4积分累计 结果判断 5分 典型DIC, 每天重复积分 5分 非典型DIC, 其后12天重复 积分Differential Diagnosis1. The coagulopathy of liver disease2. Thrombotic thrombocytopenic purpura(TTP) Triad（三联征）: microangiopathic hemolytic anemia; thrombocytopenic purpura; neurologic symptoms Pentad（五联征）: triadfever renal dysfuction 3. Primary fibriogenolysisTreatment1.Treatment of underlying disorders and supportive care 去因2.Replacement therapy 替代3.Anticoagulant therapy 抗凝 Heparin is important,b