Disseminated Intravascular Coagulation With Trauma: Treatment With Exchange Transfusion

PEDIATRICS ◽  
1979 ◽  
Vol 63 (2) ◽  
pp. 337-339
Author(s):  
Ashok P. Sarnaik ◽  
Kenneth D. Stringer ◽  
Patrick F. Jewell ◽  
Sharada A. Sarnaik ◽  
Y. Ravindranath
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Exchange Transfusion ◽  
Hypovolemic Shock ◽  
Volume Overload ◽  
Trauma Treatment ◽  
Severe Bleeding ◽  
Clotting Factors ◽  
Traumatic Injuries ◽  
Intravascular Coagulation ◽  
History Of

Disseminated intravascular coagulation (DIC) may complicate hypovolemic shock secondary to trauma.1 Treatment with heparin in such cases is contraindicated because of the risk of bleeding at the site of trauma. Replacement therapy with clotting factors and platelets alone may be inadequate2 or result in volume overload in the presence of compromised renal function. We describe here a patient with multiple intraabdominal traumatic injuries whose severe bleeding diathesis secondary to DIC was successfully treated with exchange transfusion. CASE REPORT A 10-month-old black boy weighing 10 kg was brought to Children's Hospital of Michigan, Detroit with a history of grunting for three hours and "not feeling well" for three weeks.

Hemostasis and Homeostasis

1967 ◽  
Vol 18 (03/04) ◽  
pp. 552-564
Author(s):  
J Roskam
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Blood Clotting ◽  
Research Work ◽  
Blood Stream ◽  
Severe Bleeding ◽  
Bleeding Tendency ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
Hemostatic Factors ◽  
Blood Clotting Factors

IV. General Conclusions and Summary1. Normal hemostasis depends on the combined participation of 3 sorts of hemostatic factors: vascular (including its participation in local hemodynamics), platelet and blood clotting factors, the level of which when it can be assessed largely exceeds the requirements of the organism.2. Disordered hemostasis usually results from combined moderate deficiencies of at least 2 of these factors, i.e. from an “immediate” multi-causation.3. The mechanisms of homeostasis keeping hemostatic factors production at a suitable level are still unknown.4. Inversely we have a fairly good knowledge of the mechanisms neutralizing or removing from the blood stream activated blood clotting factors and hemostatic compounds released by platelets.5. When the latter mechanisms are defective and when concomitantly, blood clotting factors and platelets are sufficiently activated and/or endothelium is widely damaged, then disseminated intravascular coagulation occurs, which may lead to deficiencies of at least 2 hemostatic factors, and hence to a more or less severe bleeding tendency.6. Thus, just as such acute or subacute hemorrhagic syndromes complicating consumption coagulopathies are based upon an “immediate” multi-causation consisting of several defective hemostatic factors, they depend on a “remote” multi-causation with respect to the origin of these joint deficiencies.7. Between both of these multi-causations, immediate and remote, there is a single pathway : an important, continuous and sufficiently rapid thrombin formation.8. This explains why the best treatment of acute and subacute hemorrhagic disorders complicating disseminated intravascular coagulation is the administration of heparin.Spaet’s and our own views are only a beginning. Most of the problems concerning relations between hemostasis and homeostasis are still unsolved, for instance nature and origin of the vascular factor impeding the arrest of bleeding in idiopathic thrombocytopenic purpura, the pathogenesis of several chronic hemorrhagic conditions associated with disseminated vascular coagulation, the influence of the nervous system, catamenia, pregnancy, etc. on various hemorrhagic syndromes, etc., to say nothing of the effects of muscular exercise on von Willebrand’s disease. They deserve systematically conducted research work.

scholarly journals Disseminated Intravascular Coagulation and Malignancy: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Sumit Sohal ◽  
Akhilesh Thakur ◽  
Aleena Zia ◽  
Mina Sous ◽  
Daniela Trelles
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Disseminated Intravascular Coagulation ◽  
Limb Ischemia ◽  
Symptomatic Treatment ◽  
Malignant Cells ◽  
Intravascular Coagulation ◽  
Fluid Analysis ◽  
History Of

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.

scholarly journals Successful treatment of an adult with Kasabach-Merritt syndrome using thalidomide, vincristine, and prednisone

2019 ◽  
Vol 47 (4) ◽  
pp. 1810-1814
Author(s):  
Yue-Hua Huang ◽  
Dao-Bin Zhou ◽  
Bing Han ◽  
Tian Li ◽  
Shu-Jie Wang
Keyword(s):  
Treatment Regimen ◽  
Disseminated Intravascular Coagulation ◽  
Tumor Regression ◽  
Severe Bleeding ◽  
Intravascular Coagulation ◽  
Subcutaneous Mass ◽  
Low Incidence ◽  
Disease Free ◽  
Novel Therapeutic

Objective Kasabach-Merritt syndrome is a rare disease that mainly occurs in infants and adolescents. It usually manifests as disseminated intravascular coagulation and severe bleeding, and is associated with high mortality. However, its low incidence and clinical rarity in adults mean that there is currently no well-verified treatment regimen for this disease. We report on an effective novel therapeutic regimen in a patient with Kasabach-Merritt syndrome. Methods A woman with Kasabach-Merritt syndrome presented with a recurrent subcutaneous mass and disseminated intravascular coagulation, and was treated with prednisone, vincristine and thalidomide. Results This treatment regimen successfully resolved the patient’s symptoms, with tumor regression. The patient remained disease-free after 6 years of follow-up. Conclusions Prednisone combined with vincristine and thalidomide may be an effective treatment for Kasabach-Merritt syndrome, but further studies are needed to verify the use of this regimen.

Case 17: Severe bleeding complications, lymphocytosis and leukoerythroblastosis – disseminated intravascular coagulation in a patient with metastasizing carcinoma of the prostate and chronic lymphocytic leukemia

1999 ◽  
Vol 56 (9) ◽  
pp. 533-536 ◽  
Author(s):  
Solenthaler ◽  
Lämmle
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Disseminated Intravascular Coagulation ◽  
Lymphocytic Leukemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Disseminierte Intravasale Gerinnung ◽  
Intravascular Coagulation ◽  
Carcinoma Of The Prostate

Blutungskomplikationen bei chronischer lymphatischer Leukämie (CLL) stehen meist in Zusammenhang mit einer Thrombozytopenie, bedingt entweder durch eine direkte Verdrängung der Megakaryopoese bei diffuser Knochenmarksinfiltration oder durch einen vermehrten peripheren Verbrauch im Rahmen einer (sekundären) Immunthrombozytopenie. Eine disseminierte intravasale Gerinnung (DIC) gehört nicht zum Spektrum hämatologischer Komplikationen einer CLL. Das hier geschilderte Fallbeispiel eines Patienten mit schweren Blutungskomplikationen, labormäßigen Zeichen einer DIC und neu entdeckter CLL ließ eine Ursache der DIC vermissen. Das leukoerythroblastäre Blutbild lieferte den Schlüssel zur Diagnose eines metastasierenden Prostatakarzinoms, welches durch die Knochenmarksbiopsie bestätigt wurde und als Trigger für die DIC verantwortlich war.

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

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 8S-28S ◽  
Author(s):  
Chrysoula Papageorgiou ◽  
Georges Jourdi ◽  
Eusebe Adjambri ◽  
Amanda Walborn ◽  
Priya Patel ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Bleeding Risk ◽  
Therapeutic Strategies ◽  
Phase Iii ◽  
Clotting Factor ◽  
Clotting Factors ◽  
Intravascular Coagulation ◽  
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.

Disseminated Intravascular Coagulation: A Clinical/Laboratory Correlation In 48 Patients

1981 ◽  
Author(s):  
R L Bick
Keyword(s):  
Platelet Count ◽  
Disseminated Intravascular Coagulation ◽  
Clinical Laboratory ◽  
Fibrinogen Level ◽  
Degradation Products ◽  
Severe Bleeding ◽  
Thrombin Time ◽  
Intravascular Coagulation ◽  
At Iii ◽  
Pre Treatment

Disseminated intravascular coagulation (DIC) is a frequent clinical entity spanning from a moderately severe bleeding disorder to a catastrophic, fulminant, and often fatal form usually associated with hemorrhage or, less commonly,as diffuse thromboses. The clinical and laboratory features of DIC remain confusing and controversial. To critically evaluate the usefulness of coagulation tests in aiding in the diagnosis and monitoring of therapy in DIC the clinical and laboratory findings were summarized in 48 patients with DIC. All patients were subjected to a prothrombin time (PT), activated partial thromboplastin time (PTT), reptilase time (RT), thrombin time (TT), fibrin(ogen) degradation products (FDP), platelet count, protamine sulfate test (PSO4), fibrinogen determination, and biological antithrombin-III (AT-III) level at the time of diagnosis. In addition, these same laboratory modalities were used to monitor patients during and after therapy. In this series of 48 patients, 38 patients had acute DIC and 10 patients had chronic DIC. In those patients with acute DIC, 100% of patients presented with hemorrhage and 53% of patients had thrombosis; 26% of patients died of their DIC type syndrome. In those patients with chronic DIC, 100% presented with hemorrhage, 80% presented with thrombosis, and none died of their intravascular clotting process. The probability of a pre-treatment abnormality in acute DIC was: FDP > AT-III = platelet count PS04 > TT > PT > fibrinogen level > PTT > RT. The probability of pre-treatment abnormalties in chronic DIC was: FDP > PSO4 = PT > AT-III = RT platelet count fibrinogen level = TT. These studies suggest the FDP level, the AT-III level, PSO4, and fibrinogen level to be reliable for aiding in the diagnosis of acute DIC. In chronic DIC the fibrinogen level, PS04, PTT, and AT-III level appear to be the most reliable indicies.

scholarly journals Disseminated intravascular coagulation in an under-recognised zoonotic infection

2017 ◽  
Vol 16 (3) ◽  
pp. 138-141
Author(s):  
Sarah Lawrence ◽  
◽  
Andrew Claxton ◽  
Mark Holland ◽  
Jack Hodd ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Platelet Transfusion ◽  
Purpura Fulminans ◽  
Blood Cultures ◽  
Organ Support ◽  
Zoonotic Infection ◽  
Intravascular Coagulation ◽  
Prompt Treatment ◽  
History Of

A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic. Treatment is with penicillins and fluoroquinolones. Identification of risk factors for unusual organisms and recognition of DIC allowing prompt treatment is critical for the acute physician.

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