Risk Of Disseminated Intravascular Coagulation Research Articles

Management of Disseminated Intravascular Coagulation in Emergency: A Review

Disseminated intravascular coagulation (DIC) is life threatening disease it’s often associated with sepsis, which require ICU management. In individuals with sepsis, the risk of DIC is especially high, DIC affects 30 to 50 percent of these individuals. Also it affects only about ten percent of patients with solid tumors, trauma, or obstetric emergencies. Hematological malignancies, aneurysms, and liver diseases can also cause the disease, the treatment for DIC focuses on resolving the underlying problem that led to this condition in the first place. As a result, antibiotics for severe sepsis, delivery in the case of placental abruption, and exploratory surgical intervention in the case of trauma are the pillars of DIC treatment, Patients with active bleeding or a high risk of bleeding, as well as those who require an invasive surgery, should consider platelet and plasma transfusions. Other anti-coagulant drugs can also be used. Prothrombin complex concentrates should only be administered in an emergency, due to their possible dangers. Recombinant human soluble thrombomodulin rhTM it was developed and licensed for clinical usage in Japan in 2008, and it’s one of the novel treatments for DIC. Anti-Xa agents, Synthetic protease inhibitors, and antithrombin are another options for treatment. In this article we will be making overview of the disease, it’s etiology an what’s the current management options.

Study of Hypercoagulability in Patients with Acute Leukaemia in the Hematology Department of Teaching Hospital of Yopougon (Abidjan)

Introduction Acute leukaemia are the clonal and malignant proliferation of immature hematopoietic cells (blast), blocked in their differentiation process. There is an interaction between cancer cells and the clotting process. This could be the expression of Tissue Factor (TF) on the surface of tumor cells; or a lesion of the vascular endothelium and platelet activation. The result is an activation of clotting that can lead to disseminated Intravascular Coagulation (DIC). The objective of this study was to assess the risk of DIC occurring in patients with acute leukaemia. Methods This was a cross-sectional study for analytical purposes that took place on 40 frozen samples from the biobank of the haematology laboratory of Teaching Hospital Yopougon for which the diagnosis of acute leukaemia had been taken from myelogram. The myelogram results were accompanied by hemogram data. PTTa, QT, fibrinogen and D-Dimers were performed on these samples. The risk assessment of DIC occurred was determined on the recommendations of the International Society of Thrombosis and Hemostasis (ISTH). Results We noted a female predominance with a Sex Ratio (M / F) of 0.90. The average age of the patients was 38 years (± 23 years) with extremes ranging from 2 to 84 years. ALL represented 20 % of cases against 80 % for AMLs. Hemogram parameters were characterized by severe anaemia (Tx Hb < 6 g / dL) in 52.5 % of cases; hyperleukocytosis > 100.103 / mm3 in 35 % of cases; thrombocytopenia < 25.103 / mm3 in 40 % of case; and significant blood and spinal cord blastosis (> 80 %). The lengthening of the PTTa was observed in 50 % of cases, compared to 40% for the QT. Similarly, hyperfibrinemia was present in 65% of cases. D-Dimers were high in almost all subject (95 % of cases). According to the ISTH criteria, 17.5 % of subjects were at risk of developing a DIC. Conclusion The risk of occurrence of DIC is indeed present during acute leukaemia. The parameters of haemostasis are thus found to be crucial data in the follow-up assessment during the diagnosis of acute leukaemia.

Impact of fetal maceration grade on risk of maternal disseminated intravascular coagulation after intrauterine fetal death \u2013 A retrospective cohort study

Disseminated intravascular coagulation (DIC) is a life-threatening event that is the endpoint of a pathologically activated cascade leading to excessive consumption of platelets culminating in bleeding. Several diseases are known to be associated with DIC, some of which may also occur during pregnancy or the puerperium. One of the potential risk factors that have been considered as a potential trigger for DIC is the retention of a highly macerated fetus after intrauterine fetal death (IUFD). However, sparse evidence exists on its clinical implication on hemostasis parameters. In this retrospective single-center study, we investigated the role of fetal maceration grades 0-III on the risk of DIC in 91 women following IUFD between gestational weeks (+days) 22 + 0 and 41 + 6 between 2003 and 2017. We calculated the Erez DIC-score after consideration of maternal platelet count (PC), prothrombin time (PT) and fibrinogen (Fib) and correlated the findings with fetal maceration grade. Mean (±SD) age of women was 32.1 ± 6.7 years. Neither maternal hemostasis parameters (PC, PT, Fib), nor the Erez score showed a statistically significant difference between maceration grades 0-III with median values of 1 for all four grades (maceration grade I: range 0 to 27; I: 0 to 51; II: 0 to 52; III: 0 to 39). We therefore conclude, that the pathophysiology of DIC in women after singleton IUFD is unrelated to the degree of fetal maceration.

Disseminated Intravascular Coagulation After Embolization to Treat Acutely Bleeding Bilateral Massive Angiomyolipoma: A Case Report.

Background: Hemorrhage from an angiomyolipoma (AML) of the kidney can be life threatening and arterial embolization is the primary treatment. Embolization is less invasive than surgery, is well tolerated, and major complications are rare. We describe a case of disseminated intravascular coagulation (DIC) after embolization of a bleeding renal AML in a 44-year-old man with massive bilateral AMLs. This report aims to highlight the possibility that acute DIC could be a major complication of embolization itself and so should be considered and screened for because, if present, it requires early and aggressive management.Case Presentation: A 44-year-old man with a history of large bilateral renal AMLs associated with tuberous sclerosis complex presented with visible hematuria and abdominal pain. Renal CT revealed bleeding from the right kidney. Embolization with polyvinyl alcohol and lipiodol was urgently performed. The following day he required multiple blood transfusions and repeat embolization, this time with gelfoam and “tornado” coils. He suddenly developed DIC, cardiovascular collapse and acute renal failure requiring many days in the intensive care unit for inotropic support and renal replacement therapy.Conclusion: Arterial embolization may be associated with increased risk of DIC in the setting of treating large bleeding renal AMLs. DIC may be a direct or indirect complication of this. The clinician must act quickly to identify this and treat this complication aggressively.

Disseminated Intravascular Coagulation After Craniotomy

Disseminated intravascular coagulation (DIC) is reported in neurosurgical patients; however, the incidence of DIC after craniotomy procedures is unknown. Using a surgical database, we identified 3164 patients who underwent primary craniotomy at Mayo Clinic Rochester between January 1, 2000 and December 31, 2004. Potential cases of DIC in this population were identified using 3 search triggers, patients: (1) in whom the diagnosis of DIC was noted on their hospital discharge summary, (2) who received red blood cell-free blood products, or (3) in whom a blood fibrinogen or d-dimer concentration was assessed. Using criteria based on laboratory values, we estimated the incidence of DIC developing within 72 hours of primary craniotomy to be between 13 and 44 per 10,000 patients. Despite a low incidence of DIC, the associated mortality rate was 43% to 75%. Traumatic head injury was a significant risk factor for the development of DIC [odds ratio of trauma was in the range of 16 (95% confidence interval (CI)=5.3-49) to 29 (CI=4.0-204)]. Autologous salvaged blood was administered intraoperatively to 44 patients, and 1 of these developed DIC. Although this small sample of patients receiving salvaged blood requires caution in interpreting the results, the risk of DIC seemed to be greater with salvaged blood than without [odds ratio 24 (CI=2.5-237)]. In children, 2 of 3 patients who developed DIC had congenital malformations of the brain. Findings from this study suggest that DIC is rare after craniotomy, but is often associated with mortality.

Disseminated Intravascular Coagulation following Midtrimester Abortions

PIP: The experience of 3 healthy patients ranging in age from 15-33 years who developed clinical and laboratory evidence of disseminated intravascular coagulation (DIC) after elective, outpatient midtrimester abortions by dilatation and curettage (D and E) under general anesthesia is described. All 3 cases had fetal gestational ages over 20 weeks, difficult fetal and/or placental extractions, and evidence of clinically significant hemorrhage. Coagulation abnormalities included elevated fibrin split products, decreased platelet levels and serum fibrinogen levels, and prolonged prothrombin time and partial thromboplastin time values. In all cases, the generalized oozing abated following administration of coagulation factors, and 2 cases required no further surgery. The apparent mechanism for obstetrically related DIC is release of placental tissue thromboplastin and/or amniotic fluid, which contain a procoagulant, into the maternal venous circulation. Use of larger amounts of pitocin (80-100 U) in patients undergoing late trimester abortion might further increase uterine muscle tone, resulting in more effective constriction of uterine vessels and decreasing the absorption of thromboplastin and amniotic fluid. A minimum of 3 thick lamineria tents should be inserted into the cervical canal 12-24 hours prior to a late midtrimester abortion. The primary therapeutic objective of treating the underlying disorder was achieved by removing all fetal and placental tissues, and procoagulants were given to replace consumed factors. In conclusion, patients undergoing late midtrimester abortions by D and E appear to be at increased risk of DIC. Based on the case reports, it is recommended that the period of recovery room observation be at least 2-3 hours, that coagulation status be assessed early when signs of increased bleeding are noticed, and that therapy with procoagulants be promptly administered if coagulation studies are abnormal. Availability of blood and coagulation factors should be checked before the procedure is initiated.