scholarly journals Paraneoplastic Phenomena of Disseminated Intravascular Coagulopathy in Hepatic Angiosarcoma – Rare, Challenging and Fatal. Case Report and Literature Review

2021 ◽  
Vol 28 (2) ◽  
pp. 1
Author(s):  
Sandra Strainienė ◽  
Kipras Jauniškis ◽  
Ilona Savlan ◽  
Justinas Pamedys ◽  
Ieva Stundienė ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Treatment Guidelines ◽  
Fatal Case ◽  
Low Frequency ◽  
Abdominal Ultrasound ◽  
Disseminated Intravascular Coagulopathy ◽  
Primary Liver Tumor ◽  
Hepatic Angiosarcoma ◽  
Liver Cancers ◽  
Intravascular Coagulopathy

Background. Hepatic angiosarcoma is an uncommon, malignant, primary liver tumor, comprising 2% of liver cancers and accounting for < 1% of all sarcomas. Patients usually present with nonspecific symptoms, such as fatigue, weight loss, right upper quadrant pain, anemia, which leads to late diagnosis of an advanced stage tumor. The median life expectancy after the diagnosis of hepatic angiosarcoma is about 6 months, with only 3% of patients surviving more than 2 years. Liver failure and hemoperitoneum are the leading causes of death in patients with liver angiosarcoma. In rarer cases, it might cause paraneoplastic syndromes such as disseminated intravascular coagulopathy. The treatment of angiosarcomas is complicated as there are no established and effective treatment guidelines due to the tumor’s low frequency and aggressive nature.Case summary. We present the case of a 68-year old woman who was admitted to the hospital due to fatigueand severe anemia (hemoglobin 65 g/l). Laboratory results also revealed high-grade thrombocytopenia(8 × 109/l). The abdominal ultrasound and computed tomography scan showed multiple lesions throughout with hepatic angiosarcoma. The treatment with first-line chemotherapy (doxorubicin) was initiated despiteongoing paraneoplastic syndrome – disseminative intravascular coagulopathy. However, the disease was terminal, and the patient died 2 months since diagnosed.Conclusions. Hepatic angiosarcoma is a rare and terminal tumor. Therefore, knowledge about its manifestations and effective treatment methods is lacking. Disseminative intravascular coagulopathy is a unique clinical characteristic of angiosarcoma seen in a subset of patients.

Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan

2021 ◽  
pp. 109980042110172
Author(s):  
Eman Mahmoud Qasim Emleek ◽  
Amani Anwar Khalil
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Scoring System ◽  
Elevated Serum ◽  
Underlying Disease ◽  
Disseminated Intravascular Coagulopathy ◽  
Period Prevalence ◽  
Lower Baseline ◽  
Intravascular Coagulopathy

Background: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. Methods: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. Results: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count ( t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level ( M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non–Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non–Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT ( U = 2,298, z = 5.7, p < 0.001), PTT ( U = 2,334, z = 2.0, p = 0.045) and INR ( U = 2,541, z = 5.1, p < 0.001) compared to those with non–Overt DIC. Conclusion: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Evaluation of obstetrical patients with disseminated intravascular coagulopathy – tertiary center experience

2015 ◽  
Vol 29 (18) ◽  
pp. 2929-2933 ◽  
Author(s):  
Serdar Başaranoğlu ◽  
Mehmet Sıddık Evsen ◽  
Elif Ağaçayak ◽  
Senem Yaman Tunç ◽  
Zülfikar Yılmaz ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulopathy ◽  
Tertiary Center ◽  
Intravascular Coagulopathy

scholarly journals Emergency Cardiac Surgery in Patients on Oral Anticoagulants

2021 ◽  
Author(s):  
Rami Akhrass ◽  
A. Marc Gillinov ◽  
Faisal Bakaeen ◽  
Scott Cameron ◽  
Jay Bishop ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Difficult Patient ◽  
Disseminated Intravascular Coagulopathy ◽  
Reversal Agents ◽  
Coagulation Profile ◽  
Intravascular Coagulopathy ◽  
Time To Onset ◽  
Case Basis

Emergency surgery, blood transfusion, and reoperation for bleeding have been associated with increased morbidity and mortality. Every effort is made to optimize patients preoperatively including cessation of oral anticoagulants in an attempt to normalize the coagulation profile. The recent explosive use of direct oral anticoagulants (DOACs) and antiplatelet medications has made the above more difficult. Cardiopulmonary bypass (CPB), with its associated fibrinolysis and platelet consumption, may exacerbate a pre-existing coagulopathy. In addition, the underlying surgical pathology, such as endocarditis accompanied by sepsis and disseminated intravascular coagulopathy (DIC) or aortic dissection requiring hypothermia and circulatory arrest, can aggravate an already challenged hematological profile. Ensuring a dry operative field upon entry by correcting the coagulopathy is offset by the concern of potentially hindering efforts to anticoagulate the patient in preparation for CPB, in addition to possibly creating a hypercoagulable state that could increase the risk of thromboembolic events. Management is challenging and decisions are typically made on a case-by-case basis. Surgery is delayed when possible and less invasive percutaneous options should be considered if feasible. If surgery is unavoidable, attention is paid to exercising meticulous techniques, avoiding excessive hypothermia, treating coexisting issues such as sepsis and correcting the coagulopathy with antidotes, reversal agents and blood products, with the understanding that a normal coagulation profile does not necessarily translate into hemostasis or the absence of thrombosis. Proper knowledge of the mechanism of action of the oral anticoagulants, available antidotes and their time to onset are essential in properly treating this difficult patient population.

Disseminated intravascular coagulopathy following fatal brown spider bite (necrotic arachnidism)

1972 ◽  
Vol 80 (6) ◽  
pp. 1035-1037 ◽  
Author(s):  
Hal Vorse ◽  
Paul Seccareccio ◽  
Kay Woodruff ◽  
G. Bennett Humphrey
Keyword(s):  
Disseminated Intravascular Coagulopathy ◽  
Intravascular Coagulopathy ◽  
Brown Spider ◽  
Spider Bite

Apparent Meningococcemia: Clinical Features of Disease Due to Haemophilus influenzae and Neisseria meningitidis

PEDIATRICS ◽  
1983 ◽  
Vol 72 (4) ◽  
pp. 469-472
Author(s):  
Richard F. Jacobs ◽  
Steven Hsi ◽  
Christopher B. Wilson ◽  
Denis Benjamin ◽  
Arnold L. Smith ◽  
...  
Keyword(s):  
Haemophilus Influenzae ◽  
Neisseria Meningitidis ◽  
Meningococcal Disease ◽  
Clinical Signs ◽  
Meningococcal Infection ◽  
Disseminated Intravascular Coagulopathy ◽  
Etiologic Agents ◽  
Intravascular Coagulopathy ◽  
Time Of Admission ◽  
Mean Time

To determine the etiology of apparent meningococcemia, all cases of sepsis with coagulopathy, purpura, and/or adrenal hemorrhage (Waterhouse-Friderichsen syndrome) with and without shock occurring over a 12-year period were reviewed. A total of 42 cases were identified; 30 cases were caused by Neisseria meningitidis and 12 cases were caused by Haemophilus influenzae. Compared with patients with disease caused by H influenzae, patients with meningococcal disease were older, more often male, more often contracted the disease in winter-spring, and had a longer duration of antecedent symptoms; however, none of these differences was statistically significant. All patients were febrile (&gt;38°C) and appeared toxic. Similar proportions in each group had shock and disseminated intravascular coagulopathy at the time of admission. Ten of 12 patients with H influenzae infection compared with 15/30 (P &lt; .05) with meningococcal infection were lethargic or comatose at the time of admission. Nine of 12 patients with H influenzae infection died compared with 5/30 with meningococcal disease (P &lt; .005); the mean time from onset of symptoms to death with H influenzae infection (20.7 ± 11.4 [SE] hours) was significantly shorter (P &lt; .05) than with meningococcal infection (120 ± 74.4 hours). Children with clinical signs of sepsis and with purpura, petechiae, or coagulopathy may have N meningitidis or H influenzae as etiologic agents. Initial antibiotic therapy should be directed against these pathogens.

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