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Haematological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
There is a strong correlation between increasing score and mortality. The diagnosis of DIC should encompass both clinical and laboratory information. It is important to repeat the tests to monitor this dynamic scenario.
Cancer
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Elyce Cardonick, Charlotte Maggen, Puja Patel
Patients can present with DIC. All trans-retinoic acid, ATRA, is an important component of therapy to control DIC in APL and has been safely used during pregnancy [78–80]. ATRA is given with daunorubicin. The response seen with ATRA alone versus with daunorubicin is not significant, however, it may impact relapse rate. Being similar to retinoid, ATRA is contraindicated during the first trimester. A serious side effect of ATRA is differentiation syndrome (unexplained fever, respiratory distress due to capillary leak) and is treated with steroids. Arsenic trioxide, also used with ATRA in non-pregnant women, is also teratogenic during first trimester. There are limited case reports of safe use of arsenic in the second and third trimesters [81–83].
Specific Management of PPH
Published in Gowri Dorairajan, Management of Normal and High Risk Labour During Childbirth, 2022
Role of heparin/antifibrinolytics: Each of them has a role in the ongoing DIC if given at the correct time weighing the balance of excessive bleed/thrombosis in the given case. Removing the underlying cause of DIC should take priority along with supportive treatment. Antifibrinolytics can aggravate thrombosis, and heparin can exacerbate bleeding. In subclinical or chronic DIC in the thrombotic phase, heparin has a definite role. So, in women with florid sepsis or thrombotic manifestation or predisposition as occurs in a woman with thrombophilia and severe preeclampsia, heparin should be used, but in established acute fulminant DIC with bleeding, heparin has not been shown to have a role.
Thromboelastography maximum amplitude as an early predictor of disseminated intravascular coagulation in patients with heatstroke
Published in International Journal of Hyperthermia, 2022
Longping He, Qingwei Lin, Lincui Zhong, Qingbo Zeng, Jingchun Song
We explored here the possibility of TEG for diagnosing DIC associated with heatstroke because the current diagnostic method based on a DIC score can fail to detect the condition early. As a result, many patients are diagnosed when DIC is already in a late stage and prognosis is worse [15]. TEG can quickly and accurately diagnose coagulation dysfunction, and it has shown potential for early diagnosis and monitoring of DIC associated with traumatic bleeding [16] or septic shock [17]. MA value represents stiffness of the developed clot, which is the result of the modest contribution of fibrin and the much more significant contribution of the platelets. Kim SM et al reported that MA < 60 mm was an independent predictor of septic DIC (odds ratio 5.616). In our study, MA value was negatively correlated with DIC score and MA≤ 45.4 mm was confirmed to be an independent predictor of heatstroke-induced DIC.
Disseminated intravascular coagulation: an update on pathogenesis and diagnosis
Published in Expert Review of Hematology, 2018
Marcel Levi, Suthesh Sivapalaratnam
DIC is a condition that encompasses concurrent (microvascular) thrombosis and widespread bleeding complications. The prothrombotic tendency in DIC arises from a systemic coagulation activation whereas continuing use of platelets and clotting factors are responsible for a consumption coagulopathy that enhances the risk of hemorrhage, the latter in particular in hyperfibrinolytic types of DIC. DIC does not occur by itself but is always associated with another condition, such as severe infection, malignant disease, severe (poly)trauma, or obstetric complications. In recent years a much better understanding of underlying pathways leading to the coagulopathy of DIC have been identified, including tissue factor-dependent initiation of coagulation, enhanced platelet-vessel wall interaction, loss of natural anticoagulant function, and the bidirectional interplay between inflammation and coagulation. In practice, a reliable diagnosis of DIC can be established with simple scoring algorithms that utilize readily available laboratory tests, which are likely to be routinely available in virtually all hospitals. The differential diagnosis of DIC comprises alternative explanations for thrombocytopenia in critically ill patients (including thrombotic microangiopathies, immune-thrombocytopenia, and heparin-induced thrombocytopenia), dilutional coagulopathies, and acquired inhibitors against coagulation factors.
Platelet function in disseminated intravascular coagulation: A systematic review
Published in Platelets, 2018
Mathies Appel Laursen, Julie Brogaard Larsen, Anne-Mette Hvas
The overall decreased platelet aggregation reported in DIC was surprising. A possible explanation could be that platelets are highly activated in vivo and have exhausted their granules, making them less activatable ex vivo. This is supported by the fact that platelet activation marker levels were consistently found to be high. The potential of platelet aggregation analyses such as light transmission and impedance aggregometry has not yet been established in DIC (41). A particular problem is that these methods are influenced by platelet count, which makes their use in DIC diagnostics limited due to thrombocytopenia (42–44). Only one of the included studies adjusted for platelet count (13). Recently, our group reported a model for adjustment for platelet count in impedance aggregometry in healthy whole blood (45). This approach could be investigated in DIC patients to evaluate its relevance in DIC diagnostics in a clinical setting. For research purposes, flow cytometry gives excellent opportunities for evaluating platelet function independently of platelet count (46). Future studies should also measure platelet function markers repeatedly during the course of DIC to evaluate the changes in platelet function over time.