VetPro - Veterinary Community » disease » Disseminated intravascular coagulation

Posted by: **jenvetadmin** on Thu May 21, 2009 5:06 am

jenvetnurse writes: The patient must already have a serious problem before DIC sets in.

Typical conditions that are associated with DIC include those involving dying internal tissue, widespread inflammation, red blood cell destruction, poor circulation, particulate matter in the bloodstream, or loss of blood vessel integrity.

The sooner DIC is recognized, the more likely the chance of a positive outcome.

At first, there are no signs at all, just subtle blood test changes. It is important to for the medical staff to watch for these lab changes in patients known to have diseases associated with DIC.

There are several factors that go into the diagnosis of DIC and a patient need not have them all:

Low platelet count:

Platelets are the white blood cells that are involved in clotting blood. In DIC, they are depleted.

Evidence of inappropriate bleeding:

This could be bruising in the skin, excessive bleeding after a blood sample is taken, or spontaneous bleeding from the gums or from any orifice.

Increases in Blood Clotting Times:

Tests called the PT and PTT are run to assess how long different blood clotting proteins take to produce a blood clot. These times are compared to standardized “normal” times. Increased clotting times indicate a tendency to bleed inappropriately. Clotting times well below the normal range can indicate a hypercoagulable state.

Presence of Fibrin Degradation Products:
(sometimes called “fibrin split products”)
Fibrin is the material that clots are made of. When antithrombin and other biochemicals remove clots, fibrin fragments become detectable.

These are fibrin degradation products. A fibrin degradation product of note is called the “D-Dimer.” It is notable because there are in-hospital test kits that can be used to detect it.

The presence of D-dimer definitely indicates that a clot has been made and broken down (though, there are many reasons for such a thing to have occurred other than DIC).

The absence of D-Dimer rules out DIC with 95% confidence.

Reduced Fibrinogen blood levels:

Fibrinogen is a fibrin precursor and its absence suggests depletion. The use of fibrinogen reduction as a marker for DIC has been questioned because there are numerous other factors that can reduce fibrinogen.

TREATMENT:

Ultimately what all this clotting and bleeding comes down to is loss of blood flow to the tissues and treatment centers on restoring normal circulation.

This means intravenous fluid administration is crucial to restore tissue perfusion. Often plasma transfusion are used to replenish consumed blood clotting proteins. Plasma is often incubated with an anticoagulant substance called “heparin” before it is administered. Heparin activates anti-thrombin, which, as mentioned, has been depleted in DIC.

The most significant factor in the treatment of DIC is removal of the original disease that predisposed the patient to DIC in the first place. If this can be achieved, it would be the best chance at resolving DIC.

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