醫(yī)學(xué)教學(xué)課件：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 fibrino

2、lysis(plasmin纖溶酶) Clinical feature:hemorrhagic and thrombotic complications Definition(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

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

4、Tissue injury組織損傷: extensive trauma, burns, operatoin, heat stroke Other causes: serious diseases of various systems,ABC incompatible blood transfusoin, snake envenomation,hemangiomas Pathogenesis Tissue factor(TF組織因子) TF. aTenase complexprothrombinase complexthrombinfibrin formation, platelets aggr

5、egation, plasmin The failure of coagulation inhibitory mechanisms Pathology and Pathophysiology Microvascular thrombosis血栓(fibrin or fibrin-platelet thrombi) Abnormality of coagulatoin function凝血功 能異常(hypercoagulating stageconsumptive hypocoagulating stagesecondary fibrinolysis) Disfunction of micro

6、circulation(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

7、 血小板 Fibrinogen level 纖維蛋白原 Prothrobin time(PT) 凝血酶原時(shí)間 3P test ,D-dimer,FDP level 纖溶指標(biāo) Thrombin time(TT) Partial thromboplastin time(APTT) AT- level,plasminogen level,F:C activity Fragmented RBC examination and count Diagnosis There are primary iniciating diseases Two or more than two kinds of clini

8、cal manifestation:bleeding; shock; thromboembolism; effective to anticoagulant therapy Three or more than three associated abnormal laboratory findings 國(guó)際血栓止血學(xué)會(huì)DIC診斷標(biāo)準(zhǔn) 1風(fēng)險(xiǎn)評(píng)估：病人是否存在已知與明顯的DIC發(fā)病 相關(guān)的潛在疾??？ 是進(jìn)入程序 否退出 凝血指標(biāo)檢測(cè) 血小板計(jì)數(shù) 纖維蛋白相關(guān)標(biāo)志（可溶性纖維蛋白單體FDPs） PT 纖維蛋白原水平 3凝血指標(biāo)檢測(cè)結(jié)果與積分 血小板計(jì)數(shù)(109/L)： 100=0 100=1 50

9、=2 可溶性纖維蛋白單體FDPs： 無(wú)增加=0 中度增加=2 顯著增加=3 PT延長(zhǎng) 3s,6s=2 纖維蛋白原水平: 1.0g/L=0 1.0g/L=1 4積分累計(jì) 結(jié)果判斷 5分 典型DIC, 每天重復(fù)積分 5分 非典型DIC, 其后12天重復(fù) 積分 Differential Diagnosis 1. The coagulopathy of liver disease 2. Thrombotic thrombocytopenic purpura(TTP) Triad（三聯(lián)征）: microangiopathic hemolytic anemia; thrombocytopenic purpura; neurologic symptoms Pentad（五聯(lián)征）: triadfever renal dysfuction 3. Primary fibriogenolysis Treatment 1.Treatment of underlying disorders and supportive care 去因 2.Replacement therapy 替代 3.Anticoagulant therapy 抗凝 Heparin is important,but