A 40-year-old male patient was admitted with acute pancreatitis . He developed fever, tachycardia, hypotension, and respiratory distress on the 3rd day of admission. His abdomen was severely tender and distended. Next morning the nurse noticed excessive oozing from arterial and central line insertion site, and his abdomen was further distended. Show
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Learn about institutional subscriptions Alessandro Squizzato UOC, Medicina I. Supportive management strategies for disseminated intravascular coagulation. An international consensus. Thromb Haemost. 2016;115(5):896–904. A review article which provide evidence and expert-based recommendations on the optimal supportive haemostatic and antithrombotic treatment strategies for patients with DIC based on five relevant clinical scenarios explained by international experts CrossRef Google Scholar Levi M. Current understanding of disseminated intravascular coagulation. Br J Haematol. 2008;124:567–76. A very good review on pathogenesis of DIC CrossRef Google Scholar Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol. 2009;145:24–33. are evidence-based guidelines diagnosis and management of DIC CrossRef CAS Google Scholar Napolitano LM, Warkentin TE. Heparin-induced thrombocytopenia in the critical care setting: diagnosis and management. Crit Care Med. 2006;34(12):2898–911. This review article summarizes the pathogenesis and clinical consequences of HIT, describes the diagnostic process, and reviews currently available treatment options CrossRef CAS Google Scholar Rice TW, Wheeler AP. Coagulopathy in critically ill patients: part 1: platelet disorders. Chest. 2009;136(6):1622–30. This article reviews the most frequent causes of thrombocytopenia by providing an overview of the following most common mechanisms: impaired production, sequestration, dilution, and destruction. Guidelines for treating thrombocytopenia and platelet dysfunction are also provided CrossRef Google Scholar Thachil J. Disseminated intravascular coagulation a practical approach. Anesthesiology. 2016;125:230–6. A practitioner guide for the management of DIC CrossRef Google Scholar Thachil J, Warkentin TE. How do we approach thrombocytopenia in critically ill patients? Br J Haematol. 2017;177:27–38. A review of an approach to thrombocytopenia CrossRef Google Scholar Toh CH, Alhamdi Y, Abrams ST. Current pathological and laboratory considerations in the diagnosis of disseminated intravascular coagulation. Ann Lab Med. 2016;36(6):505–12. This is a concise review article that provide a practical diagnostic tool for acute DIC, a composite scoring system using rapidly available coagulation tests. Its usefulness and limitations are discussed alongside the advances and unanswered questions in DIC pathogenesis CrossRef CAS Google Scholar Vincent JL, Francois B, Zabolotskikh I. Effect of a recombinant human soluble thrombomodulin on mortality in patients with sepsis-associated coagulopathy: the SCARLET randomized clinical trial. JAMA. 2019;321(20):1993–2002. Randomised controlled trial of patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. The primary end point was 28-day all-cause mortality. 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group. The incidence of major bleed was somewhat higher in the thrombomodulin group CrossRef CAS Google Scholar Website
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Rights and permissionsReprints and Permissions Copyright information© 2020 Springer Nature Singapore Pte Ltd. About this chapterCite this chapterPatil, V., Amin, N., Ambulkar, R., Kulkarni, A. (2020). Disseminated Intravascular Coagulation and Thrombocytopenia. In: Chawla, R., Todi, S. (eds) ICU Protocols. Springer, Singapore. https://doi.org/10.1007/978-981-15-0902-5_8 How does DIC cause thrombocytopenia?Etiology of DIC
Both tPA and plasminogen attach to fibrin polymers, and plasmin (generated by tPA cleavage of plasminogen) cleaves fibrin into D-dimers and other fibrin degradation products. DIC can, therefore, cause both thrombosis and bleeding (if the consumption of platelets and/or coagulation factors is excessive).
Is thrombocytopenia associated with DIC?Thrombocytopenia is often present in patients with DIC but can also occur in a number of other critical conditions. Of note, many of the rare thrombocytopenic diseases require prompt diagnoses and specific treatments.
What is the difference between DIC and thrombocytopenia?Thrombotic thrombocytopenic purpura (TTP) – hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy superficially like DIC, but distinctly different; in contrast to DIC, the mechanism of thrombosis is not via the tissue factor (TF)/factor VIIa pathway. Results of blood coagulation assays in TTP-HUS are normal.
What happens to the platelets during DIC?Patients with DIC have a low or rapidly decreasing platelet count, prolonged global coagulation tests, low plasma levels of coagulation factors and inhibitors, and increased markers of fibrin formation and/or degradation, such as D-dimer or fibrin degradation products.
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