Chapter 110. Coagulation Disorders (Part 7)

Disseminated Intravascular Coagulation DIC is a clinicopathologic syndrome characterized by widespread intravascular fibrin formation in response to excessive blood protease activity that overcomes the natural anticoagulant mechanisms. DIC is associated with several underlying pathologies (Table 110-2). The most common causes are bacterial sepsis, malignant disorders such as solid tumors or acute promyelocytic leukemia (APL), and obstetric causes. DIC is diagnosed in almost half of pregnant women with abruptio placentae or with amniotic fluid embolism. Trauma, particularly to the brain, can also result in DIC. The exposure of blood to phospholipids from damaged tissue, hemolysis, and endothelial damage are all...
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Chapter 110. Coagulation Disorders (Part 7) Chapter 110. Coagulation Disorders (Part 7) Disseminated Intravascular Coagulation DIC is a clinicopathologic syndrome characterized by widespreadintravascular fibrin formation in response to excessive blood protease activity thatovercomes the natural anticoagulant mechanisms. DIC is associated with severalunderlying pathologies (Table 110-2). The most common causes are bacterialsepsis, malignant disorders such as solid tumors or acute promyelocytic leukemia(APL), and obstetric causes. DIC is diagnosed in almost half of pregnant womenwith abruptio placentae or with amniotic fluid embolism. Trauma, particularly tothe brain, can also result in DIC. The exposure of blood to phospholipids fromdamaged tissue, hemolysis, and endothelial damage are all contributing factors tothe development of DIC in this setting. Purpura fulminans is a severe form of DICresulting from thrombosis of extensive areas of the skin; it affects predominantlyyoung children following viral or bacterial infection, particularly those withinherited or acquired hypercoagulability due to deficiencies of the components ofthe protein C pathway. Neonates homozygous for protein C deficiency alsopresent high risk for purpura fulminans, with or without thrombosis of largevessels. Table 110-2 Common Clinical Causes of Disseminated IntravascularCoagulation Sepsis Bacterial Staphylococci, streptococci, pneumococci, meningococci, gram-negativebacilli Viral Mycotic Parasitic RickettsialTrauma and tissue injury Brain injury (gunshot) Extensive burns Fat embolism RhabdomyolysisVascular disorders Giant hemangiomas (Kasabach-Merrit syndrome) Large vessel aneurysms (e.g., aorta)Obstetric complications Abruptio placentae Amniotic fluid embolism Dead fetus syndrome Septic abortionCancer Adenocarcinoma (prostate, pancreas, etc) Hematologic malignancies (acute promyelocytic leukemia)Immunologic disorders Acute hemolytic transfusion reaction Organ or tissue transplant rejection Graft-versus-host diseaseDrugs Fibrinolytic agents Aprotinin Warfarin (especially in neonates with protein C deficiency) Prothrombin complex concentrates Recreational drugs (amphetamines)Envenomation Snake InsectsLiver disease Fulminant hepatic failure Cirrhosis Fatty liver of pregnancyMiscellaneous Shock Respiratory distress syndrome Massive transfusion