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Dr. Ayaz Lone
An acquired syndrome
characterized by the
intravascular activation of
coagulation with loss of
localization arising from
different causes.
 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
 Sepsis/ Severe infections
 Trauma
 Organ destruction
 Severe pancreatitis
 Malignancies
 Solid Tumors
 Leukaemias, Acute Promyelocytic
 Lymphoproliferative disorders
 Myeloproliferative syndromes
 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
 Massive blood loss with inadequate fluid
replacement therapy
 Severe hepatic failure
 Vascular abnormalities
 Severe burns
 Activation of Blood Coagulation
 Suppression of Physiologic Anticoagulant
Pathways
 Impaired Fibrinolysis
 Cytokines
 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
 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
 Impaired Fibrinolysis
 relatively suppressed at time of maximal activation
of coagulation due to increased plasminogen
activator inhibitor type 1
 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
DIC
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
 CBC
 Platelet count
 Peripheral Smear
 Coagulation Profile
 PT
 APTT
 Serum Fibrinogen
 Fibrinogen degradation products ( FDP’s)
 D-Dimers
 Fragments
 Schistocytes
 Paucity of platelets

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DIC

  • 2. An acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes.
  • 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.  Sepsis/ Severe infections  Trauma  Organ destruction  Severe pancreatitis  Malignancies  Solid Tumors  Leukaemias, Acute Promyelocytic  Lymphoproliferative disorders  Myeloproliferative syndromes
  • 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.  Massive blood loss with inadequate fluid replacement therapy  Severe hepatic failure  Vascular abnormalities  Severe burns
  • 7.  Activation of Blood Coagulation  Suppression of Physiologic Anticoagulant Pathways  Impaired Fibrinolysis  Cytokines
  • 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.  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.  Impaired Fibrinolysis  relatively suppressed at time of maximal activation of coagulation due to increased plasminogen activator inhibitor type 1
  • 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
  • 13. 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
  • 14.  CBC  Platelet count  Peripheral Smear  Coagulation Profile  PT  APTT  Serum Fibrinogen
  • 15.  Fibrinogen degradation products ( FDP’s)  D-Dimers
  • 16.  Fragments  Schistocytes  Paucity of platelets