2. Disseminated Intravascular
Coagulopathy(DIC)
Definition: Is a hematological condition that’s
associated with thromboheamorrhagic disorders.
Normal coagulation pathway
In order to understand the change in DIC it is essential
to have a fund knowledge of the normal coagulation
mechanism:
The coagulant response is initiated with formation of
tissue factor & subsequent binding to factor VII a .
As a result factor X is activated and thus prothrombin is
converted to thrombin (factor IIa)
Thrombin play a major role in procoagulation , and
anticoagulantion
3. Pathophysiology
The underlying pathophysiology of DIC is
systemic activation of the coagulation cascade
leading to extensive fibrin deposition and
subsequent microvascular thrombosis.
Furthermore patient exhibit a tendency for sever
bleeding associated with consumption of
platelets and coagulation factors .
4.
5. Causes of DIC
Non obstetrical causes
Trauma. Sepsis. Organ damage. Malignancy. Vascular aneurysm. Acute liver failure.
Toxic and immunological causes. ABO incompatibility.
Obstetrical causes
Placental abruption ; 37%.
Postpartum bleeding ;29%.
Placenta Previa and accrete .
Sever preeclampsia and HELLP syndrome; 14%.
Acute fatty liver of pregnancy ; 8%.
Sepsis ; 6%.
Amniotic fluid embolism ;6%.
Intrauterine fetal loss.
6. Clinical features
Bleeding ; is usually the most frequent clinical finding. It manifests itself usually
as ecchymosis, petechial , mucosal oozing, prolonged bleeding at vein puncture
sites, surgical incision sites and from various systems especially the
gastrointestinal system.
Altered mental status.
Acute renal failure.
Hypoxia.
Hypovolemic shock
Abdominal compartment syndrome
7. Diagnosis
There is no single laboratory test to diagnose DIC. The diagnosis is established based
on clinical suspicion and supportive laboratory tests, these tests reflect only the
conditions at a moment in time so repeating it aids in establishing the diagnosis.
Scoring used in DIC diagnosis
The international society of Thrombosis Hemostasis (ISTH) develop a scoring system
for the diagnosis of DIC, this system is only appropriate for patients with an underlying
disorder that can be associated with DIC.
The scoring is done based on;
Thrombocyte count
Fibrin split products or D-Dimer
Prolongation of prothrombin time (PT)
Fibrinogen levels
A score of five and higher is considered as overt DIC.
8.
9. Treatment
The treatment of DIC decided by multidisciplinary team involve obstetrician,
physician, hematologist and anesthetist.
The main goal of the treatment is to correct the underlying obstetrical cause. Once
the precipitating cause is addressed DIC usually resolves. Besides, supportive
treatment should be implemented to correct the coagulation disorders.
10. Replacement of blood and blood products
*Whole blood
Contain 500 ml lead to
Increase serum fibrinogen by 12.5 mg/dl
Platelet count by 10000-15000cells.
11. *Platelet suspensions
Administered to patients with platelet counts less than
50x109 and actively bleeding .
In patients without bleeding, platelet transfusion is
limited to patients with platelet count less than 30x109 .
Platelet: 1 pint contain 50 ml increase platelet count by
5000-10000 cells
12. *Fresh frozen plasma(FFP) administration
Is indicated if active bleeding occurs in the
setting of prolonged prothrombin time (PT) and
activated partial thromboplastin time(APTT) at
a dose of 10-20 ml/kg.
FFP *1 Pint contain 250 ml
*1 L (4 Pints) increase serum fibrinogen by
5-10 mg/dl .
13. In congenital isolated fibrinogen deficiencies with level less than 1 g/l, cryoprecipitate
or fibrinogen concentrates should be used.
Cryoprecipitate
1 pint contain 40 ml
2 pints increase serum fibrinogen by 1 g
