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Disseminated Intravascular Coagulation - Pediatric Critical Care - Lecture Slides, Slides of Pediatrics

Disseminated Intravascular Coagulation, Hemostasis Review, Coagulation Cascade, Vascular Endothelium, Anticlotting Mechanisms, Fibrinolytic System, Blood Flow Dynamics. Its part of complete lecture series on Pediatric Critical Care course. Above terms are showing main points from this lecture.

Typology: Slides

2011/2012

Uploaded on 12/14/2012

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Disseminated Intravascular Coagulation
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Download Disseminated Intravascular Coagulation - Pediatric Critical Care - Lecture Slides and more Slides Pediatrics in PDF only on Docsity!

Disseminated Intravascular Coagulation

DIC

  • An acquired syndrome characterized by systemic intravascular coagulation
  • Coagulation is always the initial event.
  • Most morbidity and mortality depends on extent of intravascular thrombosis
  • Multiple causes

Vascular Endothelium

  • Vascular endothelium

expresses :

  • Thrombomodulin
  • Tissue Plasminogen Activator
  • Tissue thromboplastin/Tissue factor

Coagulation

  • Intrinsic Pathway
  • Extrinsic Pathway
  • Common Pathway
  • Contact Pathway
  • Tissue Factor Pathway
    • Primary factor in DIC

Anticlotting Mechanisms

  • Protein C
    • Activated by Thrombin/Thrombomodulin
    • Anticoagulant and fibrinolytic activity.
    • Vitamin K and Protein S are cofactors
  • Protein S

Fibrinolytic System

  • Plasmin
    • Produced from Plasminogen by Tissue Plasminogen activator (TPA)
    • Degrades Fibrin and Fibrinogen (Fibrin degradation products, FDP)
    • Degrades Factors V, VIII, IX, XI, and XII.
    • Activity is inhibited by Antiplasmin.

Pathophysiology of DIC

  • Activation of Blood Coagulation
  • Suppression of Physiologic Anticoagulant Pathways
  • Impaired Fibrinolysis
  • Cytokines

Pathophysiology of DIC

  • Activation of Blood Coagulation
    • Tissue factor/factor VIIa mediated thrombin generation via the extrinsic pathway - complex activates factor IX and X
    • TF
      • endothelial cells
      • monocytes
      • Extravascular:
        • lung
        • kidney
        • epithelial cells

Pathophysiology of DIC

  • Impaired Fibrinolysis
    • relatively suppressed at time of maximal activation of coagulation due to increased plasminogen activator inhibitor type 1

Pathophysiology of DIC - Cytokines

  • Cytokines
    • IL-6, and IL-1 mediates coagulation activation in DIC
    • TNF-α
      • mediates dysregulation of physiologic anticoagulant pathways and fibrinolysis
      • modulates IL-6 activity
    • IL-10 may modulate the activation of coagulation

Inflamation^ Coagulation

Conditions Associated With DIC

  • Malignancy
    • Leukemia
    • Metastatic disease
  • Cardiovascular
    • Post cardiac arrest
    • Acute MI
    • Prosthetic devices
  • Hypothermia/Hyperthermi a - Pulmonary - ARDS/RDS - Pulmonary embolism - Severe acidosis - Severe anoxia - Collagen vascular disease - Anaphylaxis

Conditions Associated With DIC

  • Infectious/Septicemia
    • Bacterial
      • Gm - / Gm +
    • Viral
      • CMV
      • Varicella
      • Hepatitis
    • Fungal
  • Intravascular hemolysis
  • Acute Liver Disease
    • Tissue Injury
      • trauma
      • extensive surgery
      • tissue necrosis
      • head trauma
    • Obstetric
      • Amniotic fluid emboli
      • Placental abruption
      • Eclampsia
      • Missed abortion

Microscopic findings in DIC

  • Fragments
  • Schistocytes
  • Paucity of platelets

Laboratory Tests Used in DIC

  • D-dimer *
  • Antithrombin III *
  • F. 1+2*
  • Fibrinopeptide A*
  • Platelet factor 4*
  • Fibrin Degradation Prod
  • Platelet count
  • Protamine test
    • Thrombin time
    • Fibrinogen
    • Prothrombin time
    • Activated PTT
    • Protamine test
    • Reptilase time
    • Coagulation factor levels

*Most reliable test