DIC syndrome
The content of the article:
- Causes
- Signs
- Diagnostics
- Treatment
- Prevention
- Consequences and complications
DIC syndrome (disseminated intravascular coagulation) is a pathological nonspecific process triggered by the entry into the bloodstream of factors that activate platelet aggregation (gluing) and blood coagulation. Thrombin is formed in the blood, activation and rapid depletion of plasma enzyme systems (fibrinolytic, kallikrein-kinin, coagulation) occur. This becomes the cause of the formation of aggregates of blood cells and microclots that disrupt microcirculatory blood circulation in the internal organs, which leads to the development of:
- hypoxia;
- acidosis;
- thrombohemorrhage;
- intoxication of the body with protein breakdown products and other under-oxidized metabolites;
- dystrophy and deep organ dysfunction;
- secondary profuse bleeding.
In DIC syndrome, platelet adhesion and blood coagulation are observed
Causes
The development of DIC syndrome can be complicated by many pathological conditions:
- all kinds of shock;
- obstetric pathology (for example, a missed pregnancy or premature detachment of a normally located placenta);
- acute intravascular hemolysis against the background of hemolytic anemias, poisoning with hemocoagulating and snake poisons;
- destructive processes in the pancreas, kidneys or liver;
- hemolytic uremic syndrome;
- thrombocytopenic purpura;
- generalized purulent infection, sepsis;
- malignant neoplasms;
- massive chemical or thermal burns;
- immunocomplex and immune diseases;
- severe allergic reactions;
- volumetric surgical interventions;
- profuse bleeding;
- massive blood transfusions;
- prolonged hypoxia;
- terminal states.
Signs
DIC syndrome is manifested by the development of various bleeding (from the gums, gastrointestinal tract, nose), the appearance of massive hematomas at the injection sites, etc.
A common sign of disseminated intravascular coagulation is massive hematomas at injection sites
In addition to the pathology in the blood coagulation system, changes in the disseminated intravascular coagulation syndrome affect almost all organ systems. Clinically, this is manifested by the following symptoms:
- impairment of consciousness up to stupor (but there is no local neurological deficit);
- tachycardia;
- drop in blood pressure;
- respiratory distress syndrome;
- pleural friction noise;
- vomiting mixed with blood;
- scarlet blood in the stool or melena;
- uterine bleeding;
- a sharp decrease in the amount of urine separated;
- an increase in azotemia;
- cyanosis of the skin.
Diagnostics
To diagnose DIC syndrome, laboratory tests are used:
- Measurement of antithrombin III (norm 71-115%) - its level decreases.
- Paracoagulation protamine test. Allows you to determine the monomers of fibrin in blood plasma. With disseminated intravascular coagulation it becomes positive.
- Determination of D-dimer of fibrin degradation resulting from exposure to fibrin clots of plasmin. The presence of this fragment indicates fibrinolysis (presence of plasmin and thrombin). This test is very specific for confirming the diagnosis of disseminated intravascular coagulation.
- Determination of fibrinopeptide A. Allows you to establish the breakdown products of fibrinogen. The level of this peptide in DIC syndrome is increased, which is associated with the activity of thrombin.
One of the methods for diagnosing DIC is the study of a coagulogram
Also, the number of platelets in the peripheral blood is detected, the coagulogram is examined. The main criteria for disseminated intravascular coagulation:
- prothrombin time - more than 15 seconds (the norm is 10-13 seconds);
- plasma fibrinogen - less than 1.5 g / l (normal - 2.0-4.0 g / l);
- platelets - less than 50 x 10 9 / l (the norm is 180-360 x 10 9 / l).
Treatment
Treatment for disseminated intravascular coagulation includes:
- local hemostasis;
- anti-shock therapy;
- maintenance of vital functions;
- heparin therapy;
- compensation for blood loss and treatment of its consequences;
- the use of drugs that improve microcirculation;
- transfusion of platelet concentrate with severe thrombocytopenia.
Intravenous administration of antithrombin III is indicated in severe DIC
In severe disseminated intravascular coagulation syndrome, intravenous administration of antithrombin III, which inactivates plasmin, thrombin and other coagulation enzymes, is indicated.
Prevention
Prevention of DIC development includes:
- surgical interventions using the least traumatic techniques;
- timely treatment of tumors and other pathologies that can cause disseminated intravascular coagulation;
- prevention of burns, snake bites, poisoning;
- adequate therapy for blood loss exceeding 1 liter.
Consequences and complications
The main complications of disseminated intravascular coagulation:
- respiratory distress syndrome;
- acute hepatorenal failure;
- hemocoagulation shock;
- massive bleeding;
- anemic coma;
- severe post-hemorrhagic anemia.
DIC syndrome is an extremely life-threatening pathology; its development is accompanied by high mortality. Without treatment, almost 100% of patients with disseminated intravascular coagulation (DIC) die. Actively conducted intensive care can reduce mortality rates by up to 20%.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
