Serial disseminated intravascular coagulation score with neuron specific enolase predicts the mortality of cardiac arrest—a pilot study

Disseminated Intravascular Coagulation (DIC) is a disorder of coagulation which is commonly seen as a complication of infections, traumas, obstetric diseases, and cancers especially hematological and rarely solid cancers. DIC may rarely be the presenting feature of an undiagnosed malignancy. It may present in the form of different phenotypes which makes its diagnosis difficult and leads to high mortality. The treatment comprises supportive, symptomatic treatment and removal of the underlying source. Here, we present a patient with history of being on warfarin for atrial fibrillation and other comorbidities who presented with elevated INR of 6.3 and increasing dyspnea on exertion. Over the course of her stay, her platelet counts started dropping with a concurrent decrease in fibrinogen levels. She eventually developed pulmonary embolism, followed by stroke and limb ischemia, which was indicative of the thrombotic phenotype of DIC. Her pleural fluid analysis showed huge burden of malignant cells in glandular pattern suggestive of adenocarcinoma and was started on heparin drip. However, the patient had cardiac arrest and expired on the same day of diagnosis.

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Disseminated intravascular coagulation in cardiac arrest and resuscitation

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.14480 ◽

2019 ◽

Vol 17 (8) ◽

pp. 1205-1216 ◽

Cited By ~ 5

Author(s):

Satoshi Gando ◽

Takeshi Wada

Keyword(s):

Cardiac Arrest ◽

Disseminated Intravascular Coagulation ◽

Intravascular Coagulation

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Biochip Array Analysis of Various Mediators of Inflammation in Disseminated Intravascular Coagulation

Blood ◽

10.1182/blood.v118.21.2302.2302 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2302-2302 ◽

Cited By ~ 1

Author(s):

Saud Rahman ◽

Debra Hoppensteadt ◽

Josephine Cunanan ◽

Rachael Davis ◽

Nasir Sadeghi ◽

...

Keyword(s):

Disseminated Intravascular Coagulation ◽

Conflicts Of Interest ◽

Vascular Dysfunction ◽

Tumor Necrosis Factor Receptor ◽

Neuron Specific Enolase ◽

Endothelial Damage ◽

Intravascular Coagulation ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Mediators Of Inflammation ◽

Circulating Levels

Abstract Abstract 2302 Disseminated intravascular coagulation is a polypathologic syndrome which involves blood, endothelial and target organ dysfunction resulting in the generation of various mediators of vascular dysfunction, hemostatic aberrations and hemodynamic disturbances. In addition, various disorders of target organs such as kidney, liver, heart and brain are observed. Uncontrolled protease generation results in the formation of various mediators of inflammation such as neuron specific enolase (NSE), neutrophil gelatinase associated lipocalin (NGal) and soluble tumor necrosis factor receptor 1 (TNF R1). Endothelial damage results in the generation of thrombomodulin (TM) and endogenous coagulation/fibrinolysis results in D- Dimer formation. In order to study the circulating levels of these mediators, a Biochip array method (Randox, Oceanside, CA) was utilized with samples obtained from clinically diagnosed DIC (n=100) and normal individuals (n=10). The results are summarized in the following table. Circulating levels of these mediators were markedly increased in DIC patients in comparison to normals. The most striking increase was noted in NGal (4–6 fold) and TNF R1 (10 fold). Other mediators were also increased in the DIC group, however the data was broadly scattered. These results indicate that beside the aberration in the hemostatic system NGal and TNF R1 along with other inflammatory mediators may play a major role in the pathophysiology of DIC.MarkerNormal ControlsDIC BaselineCRP (ug/ml)3.47 + 0.913.11 + 0.2*NSE (ng/ml)6.11 + 8.610.78 + 1.6*NGAL(ng/ml)306.45 + 25.51376.56 + 48.5*TNFR1 (ng/ml)0.35 + 0.013.89 + 0.3*DD (ng/ml)232.8 + 74.41318.94 + 80.5*TM (ng/ml)3.4 + 0.33.16 + 0.2 P=<0.05 Disclosures: No relevant conflicts of interest to declare.

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Fatal case of acute fatty liver of pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205812 ◽

2020 ◽

Vol 10 (1) ◽

pp. 410

Author(s):

Sarada Mamilla ◽

Sandhya Rani ◽

Gayathri . ◽

Bhavana . ◽

Ramya Bharghavi ◽

...

Keyword(s):

Cardiac Arrest ◽

Fatty Liver ◽

High Mortality ◽

Disseminated Intravascular Coagulation ◽

Fatal Case ◽

Mortality And Morbidity ◽

Intravascular Coagulation ◽

Acute Fatty Liver ◽

In Pregnancy

Acute fatty liver in pregnancy is a catstrophic condition with high mortality and morbidity. Delay in managing complications would result in fatality. We present a case of 22-year-old primi, who presented to us in labor with jaundice and later developed, disseminated intravascular coagulation, Vulval haematoma, reexploration, sepsis, ARDS and cardiac arrest and death.

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