Disseminated Intravascular Coagulation: Clinical Diagnosis and Management

Coagulation Activation ◽

Risk Of Mortality ◽

Life Threatening ◽

Inflammatory System

Disseminated intravascular coagulation (DIC) is a phenomenon with the potential for causing thrombosis and bleeding. DIC, typically occurring in patients with critical illness, can manifest as an acute, life-threatening emergency or as a chronic, subclinical process depending on the influence of morbidity from the underlying cause. The presence of DIC increases the risk of mortality by twofold in patients with trauma and severe sepsis and is an independent predictor of mortality. The pathogenesis of DIC is not only related to abnormal coagulation activation and platelet consumption but also involves multiple mechanisms of the inflammatory system and innate immunity.

Understanding Disseminated Intravascular Coagulation and Hepatobiliary Dysfunction Multiple Organ Failure in Hyperferritinemic Critical Illness*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001712 ◽

2018 ◽

Vol 19 (10) ◽

pp. 1006-1009

Author(s):

Joseph A. Carcillo ◽

Bita Shakoory ◽

Dennis Simon ◽

Kate Kernan

Keyword(s):

Critical Illness ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Intravascular Coagulation

ALK-Negative Anaplastic Large Cell Lymphoma Presenting as Disseminated Intravascular Coagulation and Hemophagocytic Lymphohistiocytosis: A Potentially Fatal Presentation

Case Reports in Hematology ◽

10.1155/2018/3465351 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Uroosa Ibrahim ◽

Amina Saqib ◽

Maryam Rehan ◽

Jean Paul Atallah

Keyword(s):

Anaplastic Large Cell Lymphoma ◽

Hemophagocytic Lymphohistiocytosis ◽

Cell Lymphoma ◽

Large Cell ◽

Lymph Node Biopsy ◽

Primary Disorder ◽

Life Threatening ◽

Large Cell Lymphoma

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder that can be familial in etiology or a result of infections, malignancy, and autoimmune or inflammatory disorders. Disseminated intravascular coagulation (DIC) is common in patients admitted to intensive care units and can confound and delay the diagnosis of HLH. We present a case of a 69-year-old female who presented with dyspnea and malaise. Her condition declined rapidly with laboratory parameters consistent with DIC. In addition, she had a ferritin of 32,522 ng/mL, low haptoglobin, and elevated LDH, and bone marrow biopsy showed hemophagocytic lymphohistiocytes. She was started on HLH-directed therapy, and later, a diagnosis of ALK-negative anaplastic large cell lymphoma was made on an excisional inguinal lymph node biopsy specimen. Our case emphasizes the importance of prompt recognition, diagnosis, and treatment of HLH while workup for a primary disorder is still being pursued.

Paraneoplastic syndromes of gynecologic neoplasms.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.3.1272 ◽

1997 ◽

Vol 15 (3) ◽

pp. 1272-1282 ◽

Cited By ~ 33

Author(s):

A A Ashour ◽

C F Verschraegen ◽

A P Kudelka ◽

J J Kavanagh

Keyword(s):

Paraneoplastic Syndromes ◽

Gynecologic Malignancies ◽

Underlying Malignancy ◽

Life Threatening ◽

Comprehensive Search ◽

Gynecologic Neoplasms

PURPOSE AND DESIGN The purpose of this review is to define and describe the paraneoplastic syndromes associated with gynecologic neoplasms. A comprehensive search of MEDLINE from 1966 to January 1996 and Cancerlit was performed. One hundred twenty-two reports were reviewed. RESULTS Twenty-four paraneoplastic syndromes have been associated with gynecologic malignancies. Six anatomic systems are affected by these syndromes. However, except for disseminated intravascular coagulation and hypercalcemia, these syndromes are rare. CONCLUSION Paraneoplastic syndromes are not frequently associated with gynecologic malignancies. The diagnosis of these syndromes is essential, as they can be occasionally life-threatening. Some paraneoplastic syndromes can be used as marker of progression or regression of the underlying malignancy.

Role of disseminated intravascular coagulation in severe sepsis

Thrombosis Research ◽

10.1016/j.thromres.2019.04.025 ◽

2019 ◽

Vol 178 ◽

pp. 182-188 ◽

Cited By ~ 3

Author(s):

Satoshi Gando ◽

Atsushi Shiraishi ◽

Kazuma Yamakawa ◽

Hiroshi Ogura ◽

Daizoh Saitoh ◽

...

Keyword(s):

Severe Sepsis ◽

Intravascular Coagulation

Hepatobiliary Dysfunction and Disseminated Intravascular Coagulation Increase Risk of Mortality in Pediatric Hemophagocytic Lymphohistiocytosis*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001684 ◽

2018 ◽

Vol 19 (10) ◽

pp. e522-e530 ◽

Cited By ~ 2

Author(s):

Jordana Goldman ◽

Moreshwar S. Desai ◽

Kenneth L. McClain ◽

M. Hossein Tcharmtchi ◽

Curtis E. Kennedy ◽

...

Keyword(s):

Hemophagocytic Lymphohistiocytosis ◽

Risk Of Mortality ◽

Increase Risk

Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618806424 ◽

2018 ◽

Vol 24 (9_suppl) ◽

pp. 8S-28S ◽

Cited By ~ 24

Author(s):

Chrysoula Papageorgiou ◽

Georges Jourdi ◽

Eusebe Adjambri ◽

Amanda Walborn ◽

Priya Patel ◽

...

Keyword(s):

Clinical Trials ◽

Severe Sepsis ◽

Bleeding Risk ◽

Therapeutic Strategies ◽

Phase Iii ◽

Clotting Factor ◽

Clotting Factors ◽

Positive Effects

Disseminated intravascular coagulation (DIC) is an acquired clinicobiological syndrome characterized by widespread activation of coagulation leading to fibrin deposition in the vasculature, organ dysfunction, consumption of clotting factors and platelets, and life-threatening hemorrhage. Disseminated intravascular coagulation is provoked by several underlying disorders (sepsis, cancer, trauma, and pregnancy complicated with eclampsia or other calamities). Treatment of the underlying disease and elimination of the trigger mechanism are the cornerstone therapeutic approaches. Therapeutic strategies specific for DIC aim to control activation of blood coagulation and bleeding risk. The clinical trials using DIC as entry criterion are limited. Large randomized, phase III clinical trials have investigated the efficacy of antithrombin (AT), activated protein C (APC), tissue factor pathway inhibitor (TFPI), and thrombomodulin (TM) in patients with sepsis, but the diagnosis of DIC was not part of the inclusion criteria. Treatment with APC reduced 28-day mortality of patients with severe sepsis, including patients retrospectively assigned to a subgroup with sepsis-associated DIC. Treatment with APC did not have any positive effects in other patient groups. The APC treatment increased the bleeding risk in patients with sepsis, which led to the withdrawal of this drug from the market. Treatment with AT failed to reduce 28-day mortality in patients with severe sepsis, but a retrospective subgroup analysis suggested possible efficacy in patients with DIC. Clinical studies with recombinant TFPI or TM have been carried out showing promising results. The efficacy and safety of other anticoagulants (ie, unfractionated heparin, low-molecular-weight heparin) or transfusion of platelet concentrates or clotting factor concentrates have not been objectively assessed.