Disseminated Intravascular Coagulation
Rodger L. Bick in Disseminated Intravascular Coagulation and Related Syndromes, 2019
Intravascular hemolysis of any etiology is a common triggering event for disseminated intravascular coagulation. Disseminated intravascular coagulation is not a disease entity, but rather an intermediary mechanism of disease that is usually seen in association with the well-defined clinical entities. This syndrome spans all areas of medicine and represents a wide clinical spectrum that remains confusing to many with respect to clinical as well as laboratory diagnosis and therapy. Patients with leukemias of either an acute or chronic variety are candidates for disseminated intravascular coagulation. The most common acute leukemia which is associated with disseminated intravascular coagulation is that of acute hypergranular promyelocytic leukemia. Hemolytic uremic syndrome, like eclampsia, shares the same pathophysiology as disseminated intravascular coagulation; however, the process often remains organ-specific and localized to the renal microvasculature. Laboratory findings of the disseminated intravascular coagulation may be highly variable and are difficult to interpret unless the pathophysiology of this disorder is firmly understood.
Supportive, Antiviral, and Immune Therapy of Patients with Ebola Virus Disease
Joseph R. Masci, Elizabeth Bass in Ebola, 2017
Ebola virus appears to produce Ebola virus diseases (EVD) only in humans and in nonhuman primates. This fact presents challenges in the clinical evaluation of antiviral therapy as well as vaccines. The lack of availability of renal replacement therapy (RRT), including hemodialysis, greatly complicates the treatment of patients in resource-deprived areas. The mainstay of supportive care of patients with EVD is replacement of gastrointestinal fluid and electrolyte losses. Gastrointestinal involvement in EVD is present in most cases and is severe in fatal cases. The rapid decline in human cases of EVD beginning in early 2015 limited the opportunities for clinical trials. Empiric treatment for malaria was commonly given during the Ebola epidemic in West Africa in 2014–2016. Infection with Ebola virus is characterized by the disruption of normal clotting pathways, particularly through the overproduction of tissue procoagulant factors. This results in disseminated intravascular coagulation (DIC) and the hemorrhagic complications associated with EVD.
Shock
Maureen Boyle, Judy Bothamley in Critical Care Assessment by Midwives, 2018
Hypovolaemic shock subsequent to antepartum or postpartum haemorrhage is the most common form of shock that midwives will encounter. Sepsis or septic shock has always posed a risk to pregnant and postpartum women, and a recent increase in cases has prompted the development of a new set of assessment tools to aid early recognition and prompt referral. Anaphylaxis is a severe, life-threating, systemic hypersensitivity reaction to a substance to which the woman has become sensitised. The pathophysiology of Amniotic fluid embolism (AFE) is unclear. It seems that amniotic fluid may enter the maternal circulation without causing problems. However, in some women, an inflammatory response can develop, causing a rapid collapse similar to anaphylaxis or septic shock. AFE usually includes a sudden cardiovascular collapse, disseminated intravascular coagulation and hypoxia, often manifesting as an altered mental state or respiratory arrest. In the UK and Ireland, at present AFE is the fifth most common cause of maternal mortality.
Bilateral orbital compartment syndrome in a patient with disseminated intravascular coagulation
Published in Orbit, 2018
Sonia Huang, Michelle T. Sun, Garry Davis, Jude Fitzgerald, Dinesh Selva, Tim Henderson
A 39-year-old male developed bilateral periorbital oedema and tense orbits in keeping with orbital compartment syndrome (OCS) shortly after presenting to the emergency department for uncontrollable epistaxis. Bilateral lateral canthotomy and inferior cantholysis was performed within 30 minutes of onset, with the left side further decompressed via superior cantholysis. Computed tomography demonstrated bilateral proptosis and optic nerve stretch, but no intraorbital haemorrhage or haematoma. Laboratory findings were consistent with disseminated intravascular coagulation (DIC) and sepsis of unknown origin. The right visual acuity recovered to 6/6 -2 from counting fingers, but the left eye failed to improve beyond light perception. This unique case of OCS is the first associated with DIC which had no evidence of intraorbital haemorrhage.
Disseminated intravascular coagulation in the HELLP syndrome: how much do we really know?
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2017
Kjell Haram, Jan Helge Mortensen, Salvatore Andrea Mastrolia, Offer Erez
The rate of disseminated intravascular coagulation (DIC) during pregnancy varies among nations from 0.03% to 0.35%. The existing reports suggest dissimilarity in the underlying mechanisms leading to DIC during gestation. While in developing countries preeclampsia and the HELLP syndrome are prevalent causes of DIC, the leading causes in the developed countries are placental abruption and postpartum hemorrhage. In different cohort studies, DIC is reported in about 12–14% of women with preeclampsia. Nevertheless, it has been suggested that in most cases these women also had a HELLP syndrome and that the occurrence of DIC in women who had only preeclampsia without manifestations of the HELLP syndrome is rare. The aims of this review are to: (1) highlight the mechanisms leading to DIC; (2) describe the changes in the coagulation system during this complication; and; (3) discuss the diagnostic tool and treatment modalities of DIC, in women who develop a HELLP syndrome.
Disseminated intravascular coagulation: an update on pathogenesis and diagnosis
Published in Expert Review of Hematology, 2018
Marcel Levi, Suthesh Sivapalaratnam
Introduction: Activation of the hemostatic system can occur in many clinical conditions. However, a systemic and strong activation of coagulation complicating clinical settings such as sepsis, trauma or malignant disease may result in the occurrence disseminated intravascular coagulation (DIC). Areas covered: This article reviews the clinical manifestation and relevance of DIC, the various conditions that may precipitate DIC and the pathogenetic pathways underlying the derangement of the hemostatic system, based on clinical and experimental studies. In addition, the (differential) diagnostic approach to DIC is discussed. Expert commentary: In recent years a lot of precise insights in the pathophysiology of DIC have been uncovered, leading to a better understanding of pathways leading to the hemostatic derangement and providing points of impact for better adjunctive treatment strategies. In addition, simple diagnostic algorithms have been developed and validated to establish a diagnosis of DIC in clinical practice.
Related Knowledge Centers
- Hemostasis
- Hemostatic Disorders
- Blood Protein Disorders
- Blood Platelet Disorders
- Blood Coagulation Disorders
- Coagulation Protein Disorders
- Hemorrhagic Disorders