DIC refers to the frequent and most severe, life-threatening disorders of the hemostatic system (hemostasis - the complex reactions of the body to prevent and stop bleeding).
Synonyms DIC - trombogemorragichesky syndrome, consumption coagulopathy, hypercoagulable syndrome defibrination syndrome.
DIC (disseminated intravascular coagulation) - is:
- secondary pathologic process that occurs at a constant and prolonged stimulation of the hemostatic system;
- pathological process having the phase current, with the initial activation and subsequent deep progressive depletion of hemostatic links up to complete loss of blood's ability to clot with the development of catastrophic uncontrolled bleeding and severe generalized hemorrhagic syndrome;
- pathological process in which there is a progressive disseminated intravascular coagulation and multiple universal blood and the formation of aggregates microclots its formed elements, which impairs its rheological characteristics, blocks microcirculation in organs and tissues, causing ischemic damage to them and leads to multiple organ defeats.
Kinds
Depending on the intensity of the formation and into the blood thromboplastin, which is formed in the destruction of cells, including blood, DIC has various clinical forms:
- lightning;
- acute;
- subacute;
- protracted;
- chronic;
- latent;
- local;
- generalized;
- compensated;
- decompensated.
Causes
Triggering factor of DIC may appear a variety of intense or prolonged stimuli, somehow fit into the Virchow triad - disorders of blood circulation, its properties or vascular wall.
DIC occurs:
1. In case of violation of the rheological characteristics of blood and hemodynamics
- any kind of shock,
- blood loss,
- intoxication,
- sepsis,
- Rh-conflict pregnancy,
- circulatory arrest and subsequent resuscitation
- gestosis,
- uterine atony,
- placenta previa,
- uterine massage
2. When the contact of blood with damaged cells and tissues
- atherosclerosis,
- fetal death,
- oncological diseases
3. When changing the properties of blood and blood entering the bulk substances tromboplasticheskih
- leukemias,
- amniotic fluid embolism,
- incompatible blood transfusion,
- septic abortion,
- detachment of normally situated placenta with bleeding in the uterus,
- placenta accreta,
- uterine rupture,
- surgery on parenchymatous organs: uterus, liver, lung, prostate, kidney;
- acute radiation sickness,
- crush syndrome,
- gangrene,
- organ transplantation, chemotherapy, pancreatic necrosis, myocardial infarction, etc.).
DIC symptoms
During DIC are 4 steps:
Stage 1 - Phase giperagretsii hypercoagulable and platelets;
Step 2 - a transitory phase (multidirectional changes in blood clotting both in the direction of hyper- and towards hypocoagulation);
Stage 3 - deep hypocoagulation phase (blood does not collapse at all);
Stage 4 - the resolution phase (or normalized hemostasis, or develop complications that lead to death).
Symptomatology of DIC depends on many factors (the causes of which it has caused, shock clinics, violations of all components of hemostasis, thrombosis, reduced the volume of the vascular bed, bleeding, anemia, malnutrition and dysfunction of target organs, metabolic disorders substances).
In the first phase there is increased clotting instant clots in large vessels and blood clots in small (during operation). The patient is not possible to take a blood test, because it is immediately minimized. As a rule, the first phase is very rapid, and goes unnoticed by doctors. It has been a sharp decrease in blood pressure, skin pale, covered with cold clammy, weak pulse (thready). Then developed respiratory failure due to lung disease, cough and crackles in the lungs, skin cyanosis, cold feet and hands.
The second phase is stored the same symptoms as in the first stage of DIC, plus involved in the process Kidney (renal failure), adrenal glands, digestive tract (nausea, vomiting, abdominal pain, diarrhea). In the brain are formed microthrombuses (headache, dizziness, convulsions, loss of consciousness up to coma, paresis and paralysis, stroke).
The third phase (step hypocoagulation) characterized by massive bleeding, both from the initial focus, as well as of other organs (Gastric and intestinal bleeding due to ulceration, blood in the urine - kidney disease, sputum with blood when expectoration).
It is also characterized by the development of hemorrhagic syndrome (occurrence of massive bleeding, bruising, petechiae, uncontrolled bleeding at injection site and during the operation, bleeding gums, bleeding from nose, etc.).
The fourth phase with timely and appropriate treatment is to restore hemostasis and stop bleeding, but often ends lethal in massive defeat of internal organs and bleeding.
Diagnostics
Basic laboratory tests:
- determining the platelet (with DIC marked decrease of platelets in the 2, 3 and 4 phases);
- clotting time (rate of 5 - 9 minutes in 1 step shortening index in subsequent - elongation time);
- bleeding time (rate of 1 - 3 minutes);
- APTT (Activated partial tromboplasticheskoe time - increase in 2 or 3 phases DIC);
- prothrombin time, thrombin time, Determination of the activated time of plasma recalcification - ABP (increase in the second and third stage of DIC);
- clot lysis (normally not in phase 3 rapid lysis and a 4-phase clot is not formed);
- fibrinogen (Rate of 2 - 4 g / l, is reduced in the 2, 3 and 4 step);
- study of the phenomenon of fragmentation of red blood cells due to damage of the threads of fibrin (normal test is negative, a positive test indicates DIC);
- decrease erythrocytes (Anemia, blood volume reduction);
- decrease in hematocrit (hypovolemia);
- determination of acid-base and electrolyte balance.
DIC Treatment
Treatment of DIC provides a doctor faced with this pathology (ie, physician), coupled with the resuscitator. In chronic course of DIC treatment takes his therapist with a hematologist.
The first step is to remove the cause of DIC. For example, in sepsis and assigned antibacterial transufizionnaya (intravenous infusion of blood products) therapy, with traumatic shock - adequate analgesia, immobilization, oxygen therapy and early surgical intervention. Or tumor diseases - chemotherapy and radiotherapy, in myocardial infarction - pain relief, recovery cardiac rhythm and hemodynamics during obstetric and gynecological pathology drastic measures (hysterectomy, cesarean section).
Recovery haemodynamic and rheological properties of the blood is performed by infusion, transfusion infusions.
Displaying the infusion of fresh frozen plasma, which not only restores blood volume, but also contains all the clotting factors.
Also introduced crystalloid (nat. solution, glucose) and colloidal solutions (polyglukin, reopoligljukin) against 4/1 and blood protein preparations (albumin protein).
Appointed anticoagulant direct action - heparin. Heparin dose depends on the stage of DIC (1 - 2 phase is significant). When significant anemia poured fresh (not more than 3 days) packed red blood cells.
In the treatment of severe generalized DIC applied fibrinogen and blood clotting factor concentrates (kriopretsipetat). Use iginbitory proteolysis - antiprotease to suppress tissue proteases that are released during cell damage (contrycal, trasilol, gordoks). Corticosteroids are also prescribed (hydrocortisone, dexamethasone), as they increase blood clotting.
In parallel, there is a struggle with multi-organ failure (support for lung, kidneys, gastrointestinal tract, adrenal glands). In 2 - 4 stages of DIC to restore local hemostasis, a mixture of aminocaproic acid, dry thrombin and sodium etamzilata adroksona. This mixture was injected into the abdominal cavity through drainages, orally, in the form of tampons in the uterus and vagina, and wipes wetted with a solution applied to the wound.
The whole process of intensive care takes 1 - 5 days (depending on the severity of DIC), and subsequent treatment is continued until complete or substantially complete reduction of all multiple organ violations.
Complications and prognosis
The main complications of DIC include:
- hemocoagulation shock (critical drop in blood pressure, disorders of the respiratory and cardiac system, etc.);
- hemorrhagic anemia;
- fatal outcome.
The prognosis depends on the severity, stage flow and DIC. In steps 1 and 2 of favorable prognosis, questionable in step 3, 4 (if an inadequate or no treatment) lethal.
