Dic

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Dic

  1. 1. Dr. Ayaz Lone
  2. 2. An acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes.
  3. 3.  An acquired syndrome characterized by systemic intravascular coagulation  Coagulation is always the initial event.  Most morbidity and mortality depends on extent of intravascular thrombosis 6 ThrombosisThrombosis FibrinFibrin Red Blood CellRed Blood Cell PlateletPlatelet WWW. Coumadin.com
  4. 4.  Sepsis/ Severe infections  Trauma  Organ destruction  Severe pancreatitis  Malignancies  Solid Tumors  Leukaemias, Acute Promyelocytic  Lymphoproliferative disorders  Myeloproliferative syndromes
  5. 5.  Obstetrical Causes  Amniotic fluid embolism  Abruptio placenta  Septic abortion  Retained products of conception  HELLP syndrome  Severe toxic or immunological reactions  Snake bites  Transfusion reactions  Transplant rejection  Recreational drugs
  6. 6.  Massive blood loss with inadequate fluid replacement therapy  Severe hepatic failure  Vascular abnormalities  Severe burns
  7. 7.  Activation of Blood Coagulation  Suppression of Physiologic Anticoagulant Pathways  Impaired Fibrinolysis  Cytokines
  8. 8.  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
  9. 9.  Suppression of Physiologic Anticoagulant Pathways  reduced antithrombin III levels  reduced activity of the protein C-protein S system  Insufficient regulation of tissue factor activity by tissue factor pathway inhibitor (TFPI)  inhibits TF/FVIIa/Fxa complex activity
  10. 10.  Impaired Fibrinolysis  relatively suppressed at time of maximal activation of coagulation due to increased plasminogen activator inhibitor type 1
  11. 11.  Cytokines  IL-6, and IL-1 mediates coagulation activation in DIC  TNF-  mediates dysregulation of physiologic anticoagulant pathways and fibrinolysis  modulates IL-6 activity  IL-10 may modulate the activation of coagulation CoagulationInflamatio n
  12. 12. SYSTEMIC ACTIVATION OF COAGULATION Intravascula r deposition of fibrin Depletion of platelets and coagulation factors Thrombosis of small and midsize vessels Bleeding Organ failure DEATH
  13. 13.  CBC  Platelet count  Peripheral Smear  Coagulation Profile  PT  APTT  Serum Fibrinogen
  14. 14.  Fibrinogen degradation products ( FDP’s)  D-Dimers
  15. 15.  Fragments  Schistocytes  Paucity of platelets
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