DIC resident survival guide: Difference between revisions
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==Do's== | ==Do's== | ||
*The transfusion of platelets should be considered for those patients actively bleeding or at an increased risk of bleeding with a platelet count of less than 50,000 microliter.<ref name="pmid19222477">{{cite journal| author=Levi M, Toh CH, Thachil J, Watson HG| title=Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. | journal=Br J Haematol | year= 2009 | volume= 145 | issue= 1 | pages= 24-33 | pmid=19222477 | doi=10.1111/j.1365-2141.2009.07600.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19222477 }} </ref> | *The transfusion of platelets should be considered for those patients actively bleeding or at an increased risk of bleeding with a platelet count of less than 50,000 microliter.<ref name="pmid19222477">{{cite journal| author=Levi M, Toh CH, Thachil J, Watson HG| title=Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. | journal=Br J Haematol | year= 2009 | volume= 145 | issue= 1 | pages= 24-33 | pmid=19222477 | doi=10.1111/j.1365-2141.2009.07600.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19222477 }} </ref> | ||
*[[Fibrinogen level should be kept at a level greater than 100mg/dl | *[[Fibrinogen]] level should be kept at a level greater than 100mg/dl | ||
*Therapy with heparin used generally for patients with low grade DIC having predominantly thrombotic episodes such as acral ischemia and thrombophlebitis. | *Therapy with heparin used generally for patients with low grade DIC having predominantly thrombotic episodes such as acral ischemia and thrombophlebitis. | ||
Revision as of 21:13, 24 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
Overview
Disseminated intravascular coagulation, is a pathological process in the body where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, and there is a paradoxically increased risk of hemorrhage.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Disseminated intravascular coagulation in itself is a life-threatening condition and must be treated as such irrespective of the causes.
Common Causes
- Abruptio placentae
- Amniotic fluid embolism
- Aortic aneurysm
- Drugs (e.g. Amphetamines)
- Eclampsia
- Giant hemangioma
- HELLP syndrome
- Hemolytic transfusion reaction
- Malignancy (especially APL)
- Sepsis
- Severe allergic reaction
- Transplant rejection
- Trauma (e.g. Fat embolism, head injury)
- Venomous snake
Management
Do's
- The transfusion of platelets should be considered for those patients actively bleeding or at an increased risk of bleeding with a platelet count of less than 50,000 microliter.[1]
- Fibrinogen level should be kept at a level greater than 100mg/dl
- Therapy with heparin used generally for patients with low grade DIC having predominantly thrombotic episodes such as acral ischemia and thrombophlebitis.
Dont's
- Do not transfuse platelets or plasma based primarily on laboratory results but should generally be for patients who are bleeding.[1]
- Don't give recombinant human activated protein C to patients with increased risk of bleeding.[1]
- Don't give recombinant human activated protein C to patients with platelet counts < 30,000 microliter.[1]
- Avoid the intravenous bolus injection of heparin of 50,000-10,000 units.
References
- ↑ 1.0 1.1 1.2 1.3 Levi M, Toh CH, Thachil J, Watson HG (2009). "Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology". Br J Haematol. 145 (1): 24–33. doi:10.1111/j.1365-2141.2009.07600.x. PMID 19222477.