39 - DISSEMINATED INTRAVASCULAR DISEASE

Summary

Disseminated intravascular coagulation (DIC) is a disorder of clotting caused by a cytokine-induced systemic inflammatory response that results in consumption of platelets, coagulation factors, and tissue factor plasma inhibitors (TFPIs). There is a wide differential diagnosis that includes thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome, systemic lupus erythematosus (SLE), catastrophic antiphospholipid syndrome (APS), and Evans syndrome. A peripheral blood smear in DIC often shows schistocytes, fragmented red blood cells (RBCs) that are formed by fibrin RBC adhesion. DIC is a major cause of stroke in medical intensive care units and is a frequent complication of a terminally ill patient. Replacement therapy with platelets and coagulation factors is given to those patients with severe bleeding. Antithrombin III is the most important of the thrombin inhibitors. It has a beneficial effect in improving coagulation factors and organ function and decreasing mortality in the majority of DIC clinical trials.