Consumptive coagulopathy

Therapy depends, where possible, on correcting the precipitating process. Thereafter, the consumption coagulopathy is reversed by intravenous injection of adequate amounts of cryoprecipitae, fresh frozen plasma and platelets at whatever interval is necessary to achieve measurable plasma levels in parallel with sustained clinical improvements. 

KO mice appeared to develop normally macroscop-ically, but possessed obvious signs of bleeding and thrombosis did not survive beyond 24 h after delivery microvascular thrombosis in the brain and necrosis in the liver plasma clottable fibrinogen was not detectable suggesting fibrinogen depletion and secondary consumptive coagulopathy (Jalbert et al. 1998). 

Jalbert LR, Rosen ED, Moons L et al. (1998) Inactivation of the gene for anticoagulant protein C causes lethal perinatal consumptive coagulopathy in mice. J Clin Invest 102 1481-1488... 

Thrombocytopenia may be caused by various metabolic disturbances (i.) synthesis disorders (e.g. medicaments, alcohol, folic acid deficiency), (2.) replacement disorders (e.g. immunologically derived degradation, consumption coagulopathy, loss of blood), and (3.) distribution disorders (e.g. increased sequestration in the enlarged spleen, involving up to 90% of the thrombocytes). 

Latent and compensated forms of consumptive coagulopathy frequently occur in the course of severe acute or chronic liver disease. In 80-85% of cirrhosis patients, the values of at least one basic test (thrombocytes. Quick s value, fibrinogen, AT III, bleeding time) are pathological. In 15-30% of cases, clinically relevant haemorrhagic diathesis evolves. 

Tab. 19.1 Haemostasis parameters showing the normal range and corresponding changes in the course of hepatogenic consumption coagulopathy up to decompensation (s. tab. 5.12)...

Thrombocyte concentrates Administration of thrombocyte concentrates may be advisable when values lower than 30,000/ il are present, but this must be specifically indicated (e.g. thrombocyte deficit due to sequestration in the spleen, increase in consumptive coagulopathy, potential antibody formation). 

Complications The possible outcome of oesophageal haemorrhage can take the following forms (7.) haemorrhagic shock, (2.) acute liver or kidney failure, (S.) hepatic encephalopathy (culminating in hepatic coma), (4.) consumptive coagulopathy, and (5.) aspiration pneumonia. 

Heparin is an anticoagulant that inhibits reactions that lead to clotting. It is indicated in prophylaxis and treatment of venous thrombosis and its extensions, pulmonary embolism (PE), peripheral arterial embolism, and atrial fibrillation with embolization diagnosis and treatment of acute and chronic consumption coagulopathies (DIC) and prevention of postoperative deep venous thrombosis. 

Clinical symptoms may vary but abdominal pain and nausea are common. Other symptoms such as hemorrhage, consumptive coagulopathy, thrombocytopenia (Kasabach-Merrit syndrome), and cardiac failure may be seen (Suchy 2003). 

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