intravascular coagulation
Introduction
Introduction Found in disseminated intravascular coagulation, also known as DIC, is caused by various causes of small blood vessels coagulation, the formation of a wide range of microthrombotic, a large number of coagulation factors are consumed, and secondary activation of fibrinolysis, resulting in a serious extensive systemic Bleeding. The disease is also known as: defibrin syndrome, consumptive coagulopathy or intravascular coagulation-defibrinolytic syndrome.
Cause
Cause
Causes of intravascular coagulation
1. Bacterial infection sepsis.
2. Malignant tumors: Pancreatic cancer, kidney cancer, prostate cancer, lung cancer, leukemia, etc.
3. Obstetric accidents: amniotic fluid embolism, early exfoliation of the placenta, miscarriage, pregnancy-induced hypertension, staying in stillbirth, uterine rupture, caesarean section, etc.
4. Other
(1) Severe head injury.
(2) Snake bites.
(3) Immune diseases such as systemic lupus erythematosus, graft rejection, and the like.
(4) Liver diseases such as acute liver necrosis, cirrhosis and other serious liver damage.
(5) elevated body temperature, acidosis, shock, hypoxia, hemolytic disease or hemolysis reaction.
Examine
an examination
Related inspection
Determination of plasma protein C activity. Simple thrombin generation test. Simple thrombin generation test.
Intravascular coagulation examination
It can be divided into acute and chronic, mainly acute, showing severe and extensive bleeding. Chronic symptoms are concealed, mainly embolism, symptoms can be covered by the symptoms of the primary disease, not necessarily a large amount of bleeding. Disseminated intravascular coagulation mainly manifests as hemorrhage, shock, embolism and hemolysis:
1. Bleeding: Acute diffuse intravascular coagulation is mainly characterized by a large number of extensive hemorrhagic episodes. Hemorrhage may vary with the primary lesion. Skin bleeding presents one or more large ecchymoses or hematomas. Vaginal bleeding, when the surgery occurs, the wound can not ooze or the blood does not coagulate. At the site of local injection, there is a pinhole for continuous bleeding. Severe cases can also have gastrointestinal, pulmonary or urinary tract bleeding. Particularly rare fulminant purpura occurs in infections, especially in children with epidemic meningitis. The purpura can develop into a clear purple-black skin necrosis and lower limb gangrene. The bleeding is mainly caused by lower limbs and buttocks.
2. Microvascular embolism symptoms: It is more obvious in chronic cases, such as malignant tumors and hemangioma patients. Thrombosis in organs is most common in the lungs and kidneys. When there are blood clots in the kidneys, there are often low back pain, hematuria, proteinuria, oliguria, and even uremia and acute renal failure. Pulmonary embolism can cause difficulty in breathing, purpura, and respiratory distress syndrome.
3. Hypotension and shock: In severe cases, the degree of shock is not proportional to the amount of bleeding.
4. Hemolysis: Often more microscopic, generally not easy to detect.
Diagnosis
Differential diagnosis
diagnosis:
It can be divided into acute and chronic, mainly acute, showing severe and extensive bleeding. Chronic symptoms are concealed, mainly embolism, symptoms can be covered by the symptoms of the primary disease, not necessarily a large amount of bleeding. Disseminated intravascular coagulation mainly manifests as hemorrhage, shock, embolism and hemolysis.
Symptoms of intravascular coagulation are easily confused :
1, severe liver disease: due to multiple bleeding, jaundice, disturbance of consciousness, renal failure, decreased platelets and fibrinogen, prolonged prothrombin time, easy to be confused with DIC. However, there was no thrombosis in liver disease, the 3P test was negative, and the dissolution time of FDP and euglobulin was normal.
2, thrombotic thrombocytopenic purpura: the disease is extensively formed in the capillary microthrombotic: microvascular hemolysis, thrombocytopenic purpura, kidney and nervous system damage, very similar to DIC. However, this disease has a characteristic transparent thrombus. There is no red or white blood cell in the thrombus. It does not involve consumptive coagulation. Therefore, prothrombin time and fibrinogen are normal and sometimes abnormal. Pathological biopsy can confirm the diagnosis.
3, primary fibrinolysis: this disease is extremely rare. Streptokinase and urokinase treatment are typical examples. This disease and DIC are extremely difficult to identify, because 1 can be induced by the same cause at the same time; 2 both have fibrinolysis characteristics: hemorrhage, elevated FDP. The difference between the two is mainly the fibrinolytic site. The secondary fibrinolysis of DIC is a physiological response to thrombosis. The typical site is limited to microcirculation; the primary fibrinolysis is in the large blood vessels, and the endothelial cells release the active factor.
