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12 results

  • Chapter 3.4 - Disseminated Intravascular Coagulation and Moschkowitz Syndrome

  • from 3 - Hypercoagulable Causes of Stroke
  • Edited by Derya Uluduz, Istanbul Üniversitesi
  • Anita Arsovska
  • Book:
    Rare Causes of Stroke
    Published online:
    06 October 2022
    Print publication:
    01 September 2022, pp 168-173

  • Summary

    Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular coagulation activation, which can arise from different causes. The diagnosis of DIC is based on a combination of clinical features, underlying condition and laboratory testing. Neurologic manifestations of DIC result in either cerebral thromboses or bleeding. Seizures, hemiparesis, aphasia, visual field disorders are common clinical signs. In the treatment of DIC, the first step would be to treat the underlying causes and thrombotic or haemorrhagic complications. Treatment with low-molecular-weight heparin in DIC may be preferred to unfractionated heparin in DIC with thrombotic complications.Thrombotic thrombocytopenic purpura (TTP) is the most common type of thrombotic microangiopathy. Pathophysiology of the acquired TTP (Moschkowitz syndrome) is combined with an increase of Willebrand factor due to a congenital or acquired deficiency of its cleaving metalloprotease (ADAMTS13). The causes of secondary Moschkowitz syndrome can be drug-associated, pregnant and postpartum patients and those with HIV or systemic autoimmune diseases. Diagnostic pentad of clinical manifestations includes microangiopathic haemolytic anaemia, severe thrombocytopenia, fever, renal involvement and various neurologic symptoms. Brain CT or MRI usually reveals small and multiple ischemic lesions, involving different arterial territories in both anterior and posterior circulations. Plasma exchange therapy, corticosteroid therapy, and rituximab (refractory or relapsed forms of the disease) are effective in patients with TTP. Oral aspirin may be prescribed at a preventive dose range until the termination of corticosteroid use

  • 3.10.1 - Disorders of Haemostasis in Intensive Care

  • from Section 3.10 - Haematological and Oncological Disorders
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 327-330

  • Summary

    Key Learning Points

    1. 1. Abnormal coagulation results are not uncommon in critically unwell patients.

    2. 2. In vitro tests do not always fully correlate with events in vivo, and so all results should be interpreted with reference to the clinical history, particularly any bleeding or thrombosis history.

    3. 3. The clinical severity of disseminated intravascular coagulation may not necessarily correlate with abnormalities seen in the laboratory tests, and an individualised plan should be made depending on the clinical scenario.

    4. 4. Patients with cirrhosis are at risk of thrombosis, as well as bleeding.

    5. 5. In a stable, non-bleeding patient with liver disease, there is no need for ‘prophylactic’ blood components unless procedures are required.

  • Clinical characteristics of COVID-19 with cardiac injury: a systematic review and meta-analysis

  • Linwen Zeng, Shihui Wang, Jianing Cai, Shaoqing Sun, Suhuai Wang, Jingjie Li, Lin Sun
  • Journal:
    Epidemiology & Infection / Volume 148 / 2020
    Published online by Cambridge University Press:
    23 October 2020, e266
    • Article
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      • Open access
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  • Objectives

    Cardiac injury is associated with poor prognosis of 2019 novel coronavirus disease 2019 (COVID-19), but the risk factors for cardiac injury have not been fully studied. In this study, we carried out a systematic analysis of clinical characteristics in COVID-19 patients to determine potential risk factors for cardiac injury complicated COVID-19 virus infection.

    Methods

    We systematically searched relevant literature published in Pubmed, Embase, Europe PMC, CNKI and other databases. All statistical analyses were performed using STATA 16.0.

    Results

    We analysed 5726 confirmed cases from 17 studies. The results indicated that compared with non-cardiac-injured patients, patients with cardiac injury are older, with a greater proportion of male patients, with higher possibilities of existing comorbidities, with higher risks of clinical complications, need for mechanical ventilation, ICU transfer and mortality. Moreover, C-reactive protein, procalcitonin, D-dimer, NT-proBNP and blood creatinine in patients with cardiac injury are also higher while lymphocyte counts and platelet counts decreased. However, we fortuitously found that patients with cardiac injury did not present higher clinical specificity for chest distress (P = 0.304), chest pain (P = 0.334), palpitations (P = 0.793) and smoking (P = 0.234). Similarly, the risk of concomitant arrhythmia (P = 0.103) did not increase observably either.

    Conclusion

    Age, male gender and comorbidities are risk factors for cardiac injury complicated COVID-19 infection. Such patients are susceptible to complications and usually have abnormal results of laboratory tests, leading to poor outcomes. Contrary to common cardiac diseases, cardiac injury complicated COVID-19 infection did not significantly induce chest distress, chest pain, palpitations or arrhythmias. Our study indicates that early prevention should be applied to COVID-19 patients with cardiac injury to reduce adverse outcomes.

  • Extremely refractory Kawasaki disease with disseminated intravascular coagulation

  • Young Kwon Koh, Jae Hee Lee, Yeong Bong Park
  • Journal:
    Cardiology in the Young / Volume 27 / Issue 5 / July 2017
    Published online by Cambridge University Press:
    07 March 2017, pp. 1004-1007

  • Disseminated intravascular coagulation is a rare complication of Kawasaki disease and appears in <0.1% of Kawasaki disease patients. We report a case of refractory Kawasaki disease complicated with disseminated intravascular coagulation and giant coronary aneurysm. A 5-month-old boy presented with Kawasaki disease with coagulopathy. Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration. Despite all efforts to treatment, the patient had giant coronary aneurysms and died suddenly.

  • Chapter 20 - Nutrition

  • from Section 3 - Special critical care tools and techniques
  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 203-216

  • Summary

    This chapter focuses on three entities namely disseminated intravascular coagulation (DIC), HELLP syndrome, and thrombotic thrombocytopenic purpura (TTP), which represents unique and critical threats to the well-being of mother and fetus during peripartum period. It is concerned with the etiology, clinical features, diagnostic methods and management of these entities. In non-bleeding patients with DIC, platelets and factor replacement should not be administered prophylactically or based on laboratory tests alone. The treatment of HELLP involves monitoring and responding to maternal signs and symptoms, particularly when pre-eclampsia is present, and includes fluid management and the use of antihypertensive agents and magnesium sulfate for seizure prophylaxis. Plasma exchange is the treatment of choice for TTP. The optimal treatment regimen for obstetric coagulation disorders continues to evolve, given the frequently dynamic clinical situation, the presence and health of the fetus, and a growing interest in conducting investigations during the peripartum period.

  • Chapter 33 - Acute gastrointestinal bleeding and perforation

  • from Section III: - Organ dysfunction and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 257-265

  • Summary

    This chapter discusses the cell-based model of coagulation, regulation of coagulation, and bleeding disorders. The disorders include congenital disorders and acquired disorders such as thrombocytopenia, disseminated intravascular coagulation (DIC) and microangiopathic haemolytic anaemia. Thrombocytopenia may occur because of impaired production, sequestration, increased consumption, and enhanced degradation. Activated protein C has been shown to reduce mortality in sepsis especially in patients with DIC and multi-organ failure. During the resuscitation of patients who have suffered a major haemorrhage, factors that can contribute to associated coagulopathy are: hypothermia, metabolic acidosis, and consumption of clotting products. Heparin-induced thrombocytopenia (HIT) usually occurs 5-10 days following exposure to heparin. It is a pro-thrombotic disorder and can lead to significant venous and arterial thrombosis. HIT usually resolves following the discontinuation of heparin over a few days. Management includes the prompt removal of all heparin containing medication and the substitution of a direct thrombin inhibitor to control clotting.

  • Prothrombin complex concentrates: a brief review

  • C. M. Samama
  • Journal:
    European Journal of Anaesthesiology / Volume 25 / Issue 10 / October 2008
    Published online by Cambridge University Press:
    01 October 2008, pp. 784-789
    Print publication:
    October 2008

  • Prothrombin complex concentrates are haemostatic blood products containing four vitamin K-dependent clotting factors (II, VII, IX and X). They are a useful, reliable and fast alternative to fresh frozen plasma for the reversal of the effects of oral anticoagulant treatments (vitamin K antagonists). They are sometimes used for factor II or factor X replacement in patients with congenital or acquired deficiencies. They are widely prescribed in Europe. Several retrospective and prospective studies have demonstrated their efficacy in normalizing coagulation and in helping to control life-threatening bleeding. Few side-effects, mainly thromboembolic events, have been reported. The link between these events and prothrombin complex concentrate infusion has, however, often been brought into question. The use of prothrombin complex concentrates in new promising indications such as the management of massive bleeding requires prospective studies providing a high level of evidence in a high-risk setting.

  • 5 - Disseminated intravascular coagulation

  • Edited by Ann Harper
  • Book:
    Haemorrhage and Thrombosis for the MRCOG and Beyond
    Published online:
    05 October 2014
    Print publication:
    01 June 2005, pp 59-71

  • Summary

    Disseminated intravascular coagulation (DIC) is characterised by an imbalance between prothrombotic and antithrombotic activities. It may complicate a wide range of clinical disorders, including tissue destruction associated with surgery or trauma, serious bacterial or non-bacterial infection, malignancy and a variety of obstetric mishaps. Increased consumption/degradation and reduced production result in low levels of the most important natural inhibitor of thrombin, antithrombin. The clinical presentation of DIC is variable. Sometimes there is little obvious apart from oozing from venepuncture sites but some patients present with serious bleeding. Obstetric complications are frequently associated with clinically severe DIC. The basis of the diagnosis of DIC is an appreciation of the underlying disorders in which DIC can develop. Acute DIC is a serious complication which carries with it a high risk of mortality. It is generally accepted that the cornerstone of management of DIC is treatment of the underlying cause.

  • 3 - Maternal and fetal thrombocytopenia

  • Edited by Ann Harper
  • Book:
    Haemorrhage and Thrombosis for the MRCOG and Beyond
    Published online:
    05 October 2014
    Print publication:
    01 June 2005, pp 27-41

  • Summary

    Thrombocytopenia in the mother and fetus is a common problem. This chapter reviews its causes, clinical significance, investigation and management. Thrombocytopenia complicating hypertensive disorders of pregnancy is responsible for about 20% of cases of maternal thrombocytopenia. The pregnancy-related causes of disseminated intravascular coagulation (DIC) include pre-eclampsia, placental abruption, amniotic fluid embolism and, rarely, retention of a dead fetus. Immune thrombocytopenia is responsible for about 4% of maternal thrombocytopenia. Most cases are due to idiopathic autoimmune thrombocytopenia, but some are drug-related and some associated with HIV infection. Neonatal thrombocytopenia has many causes, and is the most common haematological problem in the newborn infant, and probably the fetus as well. A better understanding of the risks of thrombocytopenia in pregnancy to the mother and fetus has resulted in better targeting of treatment: withholding it in low-risk situations and using intensive therapy where there is high risk.

  • Consumptive coagulopathy complicating juvenile angiofibroma

  • Campbell Baguley, Guri Sandhu, James O’Donnell, David Howard
  • Journal:
    The Journal of Laryngology & Otology / Volume 118 / Issue 11 / November 2004
    Published online by Cambridge University Press:
    08 March 2006, pp. 835-839
    Print publication:
    November 2004

  • Objective: To investigate the incidence and clinical significance of deranged clotting results among patients with juvenile (nasopharyngeal) angiofibroma.

    Methods: Twenty consecutive patients treated for juvenile angiofibroma between March 1998 and July 2002 in whom preoperative coagulation tests were performed were selected. Results were compared with normal laboratory values, and clinical and histological records were retrospectively analysed.

    Results: Four out of 20 patients were found to have abnormal tests, consistent with concurrent consumptive coagulopathies. One patient was found to have a raised D-dimer level. This resolved following removal of the lesion.

    Conclusions:The association between larger arterio-venous malformations and disseminated intravascular coagulopathy is well described (Kasabach–Merritt syndrome). Our findings suggest that low-grade consumptive coagulopathies may also complicate smaller juvenile angiofibromas, implying that preoperative coagulation screening tests may have a role in ensuring optimal perioperative haemostasis.

  • Amniotic fluid embolism and isolated coagulopathy: atypical presentation of amniotic fluid embolism

  • I. T. Awad, G. D. Shorten
  • Journal:
    European Journal of Anaesthesiology / Volume 18 / Issue 6 / June 2001
    Published online by Cambridge University Press:
    16 August 2006, pp. 410-413
    Print publication:
    June 2001

  • A 41-year-old multigravida presented at 32 weeks of gestation with polyhydramnios and an anencephalic fetus. Abnormal bleeding as a result of disseminated intravascular coagulation complicated an emergency Caesarean section for severe abdominal pain thought to be due to uterine rupture. Massive transfusion with blood products was necessary and the abdomen packed to control bleeding. The patient was transferred to the intensive care unit where she made a slow but complete recovery. Amniotic fluid embolism with atypical presentation of isolated coagulopathy is the likely diagnosis in this case. The case serves to demonstrate that amniotic fluid embolism may present with symptoms and signs other than the classical pattern of dyspnoea, cyanosis and hypotension.