A disorder of widespread micro- vascular thrombosis caused by activation of coagulation with or without bleeding caused by secondary fibrinolytic activation.micro- vascular thrombosis bleeding Definition
A 23-year woman, induced abortion, delivered one dead fetus. Case Presentation 14 hrs after parturition, convulsion and obnubilation developed. Large ecchymosis on extremities and abdomen. After parturition, profluvium sanguis from vagina constantly. BP: undetectable; platelet: 7,000; BT: 1 min; CT: 1min; PT: 18 sec; Fib:1.1g/L; 3P test (+)
Excessive clotting Infection Cancer Childbirth, dead fetus, or surgery Severe head injury Poisonous snake Clotting factors and platelets are depleted Excessive bleeding occurs Endothelial damage; tissue damage; director activation of factor X, damage of blood cells Hypercoagulable stage Hypocoagulable stage Secondary fibrinolytic stage
1.Bleeding at multiple sites (Ecchymoses of skin, mucous membranes; Visceral hemorrhage)at multiple sites 2.Organ dysfunction (Waterhouse-Friderichsen syndrome; Sheehan’s syndrome) 3.Shock 4.Hemolytic anemia (microangiopathic hemolytic anemia) Clinical findings Clinical and Laboratory Findings in DIC
Integumentary system: Widespread hemorrhage and vascular lesions, Oozing from puncture sites, incision, mucous membranes, irregular-shaped cyanotic patches Central nervous system: Subarachnoid hemorrhage, altered state of consciousness Gastrointestinal system: Occult bleeding to massive gastrointestinal bleeding; abdominal distention; malaise, weakness Pulmanary system Renal system: hematuria, oliguria, renal failure
1.Coagulation abnormalities: prolonged prothrombin time, activated partial thromboplastin time, thrombin time; decreased fibrinogen levels; increased levels of FDP (eg, “3P” test, D-dimer) “3P” test 2.Platelet count decreased as a rule but may be falling from a higher level yet still be normal 3.SchistocyteSchistocyte Laboratory abnormalities
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