Disseminated intravascular coagulation in paediatrics

2016 ◽  
Vol 102 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Revathi Rajagopal ◽  
Jecko Thachil ◽  
Paul Monagle
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Diagnostic Tests ◽  
Early Life ◽  
Clinical Manifestations ◽  
Review Article ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Intravascular Coagulation ◽  
Management Algorithm ◽  
Recent Advances

Disseminated intravascular coagulation (DIC) in paediatrics is associated with significant morbidity and mortality. Although there have been several recent advances in the pathophysiology of DIC, most of these studies were done in adults. Since the haemostatic system is very different in early life and changes dramatically with age, creating a variety of challenges for the clinician, delay in the diagnosis of DIC can happen until overt DIC is evident. In this review article, we report the aetiology, pathophysiology, clinical manifestations, diagnostic tests and a management algorithm to guide paediatricians when treating patients with DIC.

Disseminated intravascular coagulation syndrome

2020 ◽  
pp. 22-40
Author(s):  
A. Kulikov
Keyword(s):  
Clinical Practice ◽  
Disseminated Intravascular Coagulation ◽  
Blood Cells ◽  
Physical State ◽  
Clinical Manifestations ◽  
Vascular Wall ◽  
Stages Of Development ◽  
Intravascular Coagulation ◽  
Hemostatic Disorder

Presented material reveals main links in the pathogenesis of hemostatic disorder. In particular, attention is paid to the role of the lungs, liver and other organs in the development of this process. Role of vascular wall and blood cells in regulation of the physical state of blood is described in detail. The most frequent factors leading to hypercoagulation are indicated. Difference between hypercoagulation and thrombophilia is shown. The latter is found in clinical practice quite often, but at the same time, it is poorly diagnosed. Such a terrible complication of hemostatic disorder as disseminated intravascular coagulation is described. Its classification, stages of development, clinical manifestations are offered to the readers.

scholarly journals Successful application of recombinant activated factor VII in a patient with HELLP syndrome and disseminated intravascular coagulation

2008 ◽  
Vol 136 (Suppl. 3) ◽  
pp. 253-258
Author(s):  
Tatjana Ilic-Mostic ◽  
Rajka Argirovic ◽  
Radmila Sparic ◽  
Aleksandar Ljubic ◽  
Tatjana Bozanovic ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Hellp Syndrome ◽  
Morbidity And Mortality ◽  
Factor Vii ◽  
Recombinant Activated Factor Vii ◽  
Fetal Demise ◽  
Intravascular Coagulation ◽  
Activated Factor Vii ◽  
Maternal Morbidity And Mortality ◽  
Mortality Case

INTRODUCTION. HELLP syndrome represents the form of preeclampsia characterized by moderate hypertension, often with absence of proteinuria and oedema. The frequency of HELLP syndrome in pregnant women with preeclampsia is 10-20%. The clinical course of the disease is characterized by the progressive worsening of mother and fetus condition, which can be stopped only by delivery. Disseminated intravascular coagulation is present in 8% of patients with HELLP syndrome and causes significant morbidity and mortality. CASE OUTLINE. We present a case of HELLP syndrome complicated by intrauterine fetal demise and disseminated intravascular coagulation in trigemelar pregnancy. After all surgical and medicamentous methods to establish haemostasis were exhausted, the patient was treated by recombinant activated factor VII (rFVIIa) in intravenous bolus dose of 90 ?g/kg twice, which resulted in satisfactory haemostasis. Side effects of the drug were not registered. CONCLUSION. The application of rFVIIa reduced haemorrhage in our patient, both after the Caesarean section and after hysterectomy, contributing to the patient?s full recovery, without neurological sequelae and with preserved renal function. RFVIIa is not an alternative to surgical haemostasis, but its administration should surely be considered before deciding to perform hysterectomy, especially in patients who want to preserve fertility. In cases of postpartum haemorrhage, when bleeding persists even after adequate surgical haemostasis, the administration of rFVIIa is to be considered not only as an alternative to hysterectomy, but also an effort to prevent significant maternal morbidity and mortality.

scholarly journals Heparin-induced thrombocytopenia: An Update

1970 ◽  
Vol 3 (2) ◽  
pp. 187-199
Author(s):  
LA Sayami ◽  
M Ullah
Keyword(s):  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Significant Morbidity ◽  
Drug Induced ◽  
Heparin Induced Thrombocytopenia ◽  
Recent Advances ◽  
Immune Mediated

Heparin-induced thrombocytopenia (HIT) is the most important and most frequent drug-induced, immune-mediated type of thrombocytopenia. It is associated with significant morbidity and mortality if unrecognized. In this review, we briefly discuss the main features of heparin-induced thrombocytopenia, particularly analyzing the most recent advances in the pathophysiology, diagnosis and treatment of this syndrome. Keywords: Heparin; Thrombocytopenia DOI: http://dx.doi.org/10.3329/cardio.v3i2.9189 Cardiovasc. J. 2011; 3(2): 187-199

Mycobacterium tuberculosis inducing disseminated intravascular coagulation

2005 ◽  
Vol 93 (04) ◽  
pp. 729-734 ◽  
Author(s):  
Jann-Yuan Wang ◽  
Po-Ren Hsueh ◽  
Yuang-Shuang Liaw ◽  
Wen-Yi Shau ◽  
Pan-Chyr Yang ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Manifestation ◽  
Disseminated Intravascular Coagulation ◽  
Early Stage ◽  
Prognostic Significance ◽  
Clinical Manifestations ◽  
Clinical Findings ◽  
Mediastinal Lymphadenopathy ◽  
Disseminated Tuberculosis ◽  
Intravascular Coagulation

SummaryDisseminated intravascular coagulation (DIC) can develop infrequently in patients with tuberculosis and has a very high mortality rate. We conducted a retrospective study to evaluate the incidence of tuberculosis-induced DIC and to investigate the clinical manifestation, outcome, and prognostic factors of such patients. From January 2002 to December 2003, all culture-proven tuberculosis patients who developed DIC before starting anti-tuberculosis treatments were selected for this study. Patients who had other clinical conditions or were infected by other pathogens that may have been responsible for their DIC were excluded. Survival analysis was performed for each variable with possible prognostic significance. Our results showed that 27 (3.2%) out of the 833 patients with culture-proven tuberculosis had tuberculosis-induced DIC with a mortality rate of 63.0%. The most common clinical manifestations were fever (63.0%) and multiple patches of pulmonary consolidation (59.3%). Seven (25.9%) patients had disseminated tuberculosis. Twelve (44.4%) developed acute respiratory distress syndrome and three (11.1%) were associated with hemophagocytosis. Twenty-four (88.9%) patients had findings that were unusual for an acute bacterial infection, such as positive acid-fast smear, miliary pulmonary lesions, lymphocytotic exudative pleural effusion, and mediastinal lymphadenopathy. Early anti-tuberculosis treatment significantly improved survival. In conclusion, tuberculosis can cause DIC. Patients with non-miliary, non-disseminated tuberculosis could also develop the rare clinical manifestation. Since the prognosis was very poor in patients not treated at an early stage, a high index of suspicion is required, especially in those with clinical findings suggestive of tuberculosis.

Supportive management strategies for disseminated intravascular coagulation

2016 ◽  
Vol 115 (05) ◽  
pp. 896-904 ◽  
Author(s):  
Beverley J. Hunt ◽  
Gary T. Kinasewitz ◽  
Hideo Wada ◽  
Hugo ten Cate ◽  
Jecko Thachil ◽  
...  
Keyword(s):  
Platelet Count ◽  
Disseminated Intravascular Coagulation ◽  
Platelet Transfusion ◽  
Management Strategies ◽  
Clinical Manifestations ◽  
Treatment Strategies ◽  
Two Phase ◽  
Intravascular Coagulation ◽  
Clinical Scenarios ◽  
Supportive Management

SummaryThe cornerstone of the management of disseminated intravascular coagulation (DIC) is the treatment of the underlying condition triggering the coagulopathy. However, a number of uncertainties remain over the optimal supportive treatment. The aim of this study was to provide evidence and expert-based recommendations on the optimal supportive haemostatic and antithrombotic treatment strategies for patients with DIC. A working group defined five relevant clinical scenarios. Published studies were systematically searched in the MEDLINE and EMBASE databases (up to May 2014). Seven internationally recognised experts were asked to independently provide clinical advice. A two-phase blinded data collection technique was used to reach consensus. Only three randomised controlled trials (RCTs) on the supportive management of DIC were identified. The RCTs (overall less than 100 patients) investigated the use of fresh frozen plasma and platelet transfusion and found no differences in survival between the intervention and control groups. The experts’ approach was heterogeneous, although there was consensus that supportive management should vary according to the underlying cause, clinical manifestations and severity of blood test abnormalities. Platelet transfusion should be given to maintain platelet count > 50×109/l in case of bleeding while a lower threshold of 20 to 30×109/l may be used in DIC without bleeding. Thromboprophylaxis with low-molecular-weight heparin is advised until bleeding ensues or platelet count drops below 30×109/l. In conclusion, in the absence of solid evidence from RCTs, an individualised supportive management of DIC is advisable based on the type of underlying disease, presence of bleeding or thrombotic complications and laboratory tests results.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals DIAGNOSTIC CRITERIA FOR DISSEMINATED INTRAVASCULAR COAGULATION SYNDROME AND SEPSIS-INDUCED COAGULOPATHY

2021 ◽  
pp. 25-38
Author(s):  
S. O. Tarasenko ◽  
S. O. Dubrov ◽  
G. G. Suslov
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Disseminated Intravascular Coagulation ◽  
Thrombus Formation ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Multiple Organ ◽  
Review Of The Literature ◽  
Intravascular Coagulation ◽  
Current State

The clinical manifestations of disseminated intravascular coagulation syndrome (DIC) depend on the predominance of the sum of the vectors of hypercoagulation and hyperfibrinolysis and are strongly associated with the underlying disease, against which DIC is formed. The issue of understanding the complex pathogenesis, timely diagnosis of overt DIC and early manifestations of DIC remain an urgent challenge for intensive care physicians and leading specialized societies to study the problems of hemostasis and thrombus formation. This review of the literature analyzes the pathways of DIC development, the current state of the possibility of using diagnostic markers to detect DIC, especially in sepsis. The diagnosis of sepsis-induced coagulopathy against the background of the development of multiple organ failure is highlighted as a separate issue. Diagnostic scales are presented in the form of comparative tables for a more convenient perception of information, memorization and further implementation in clinical practice.

Disseminated intravascular coagulation and its immune mechanisms

Blood ◽  
2021 ◽  
Author(s):  
Narcis Ioan Popescu ◽  
Cristina Lupu ◽  
Florea Lupu
Keyword(s):  
Blood Coagulation ◽  
Disseminated Intravascular Coagulation ◽  
Clinical Manifestations ◽  
Regulatory Control ◽  
Intravascular Coagulation ◽  
Contact Pathway ◽  
Molecular Patterns ◽  
Endothelial Homeostasis ◽  
Damage Associated Molecular Patterns ◽  
New Strategies

Disseminated intravascular coagulation (DIC) is a syndrome triggered by infectious and non-infectious pathologies characterized by excessive generation of thrombin within the vasculature and widespread proteolytic conversion of fibrinogen. Despite diverse clinical manifestations ranging from thrombo-occlusive damage to bleeding diathesis, DIC etiology commonly involves excessive activation of blood coagulation and overlapping dysregulation of anticoagulants and fibrinolysis. Initiation of blood coagulation follows intravascular expression of tissue factor or activation of contact pathway in response to pathogen-associated or host derived damage-associated molecular patterns. The process is further amplified through inflammatory and immuno-thrombotic mechanisms. Consumption of anticoagulants and disruption of endothelial homeostasis lower the regulatory control and disseminate microvascular thrombosis. Clinical DIC development in patients associates with worsening morbidities and increased mortality regardless of the underlying pathology, therefore timely recognition of DIC is critical to reduce the pathologic burden. Due to diversity of triggers and pathogenic mechanisms leading to DIC, diagnosis is based on algorithms that quantify hemostatic imbalance, thrombocytopenia and fibrin/ogen conversion. Since current diagnosis primarily assesses overt consumptive coagulopathies, there is a critical need for better recognition of non-overt DIC and/or pre-DIC states. Therapeutic strategies for DIC patients involve resolution of the eliciting triggers and supportive care for the hemostatic imbalance. Despite medical care, mortality in DIC patients remains high and new strategies, tailored to the underlying pathologic mechanisms, are needed.

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