Disseminated coagulation

Blood coagulation and thrombus formation must be confined to the smallest possible area to achieve local hemostasis in response to bleeding from trauma or surgery without causing disseminated coagulation or impaired blood flow. Two major systems regulate and delineate these processes fibrin inhibition and fibrinolysis. 

Table 7-6. Conditions that may be associated with disseminated coagulation...

Shock is a constant finding in all cases of disseminated coagulation. In animal experiments, heparin injection prevents clotting and shock, and therefore it is generally accepted that shock is a direct consequence of the disseminated thrombosis. The drop in blood pressure may be slight and reversible, or it may develop into an irreversible state and lead to death. The pathogenesis of shock has been explained as follows. Sudden obstruction of liver and lung capillaries impairs the venous return to the heart, and the cardiac output is reduced. 

Afibrinogenemia is a prominent alteration in disseminated coagulation. Fibrinogen is low because like other coagulating factors, factors V, VIII, and X have been used in the coagulating process, and also because of an increase in plasmin activity. 

We have already pointed out that the local pathology of the heart and lungs may be important in determining the intensity of the symptoms. It seems that endothelial or vasomotor changes may determine the localization of the thrombi. The pathogenesis of disseminated coagulation is summarized in Fig. 7-10. 

Diagnosis and treatment of disseminated intravascular coagulation, a severe hemorrhagic disorder. 

Dantrolene should be repeated after 5—8 hr. Bicarbonate, procaine amide, and other drugs should be repeated as needed. Treatment of disseminated intravascular coagulation is symptomatic. Early diagnosis and treatment ofMH is essential. After effective treatment, the patient should be watched closely in the intensive care unit for recurrence of MH, myoglobinuric renal failure, disseminated intravascular coagulation, muscle weakness, and electrolyte imbalance. 

Fatal anaphylaxis occurs mostly due to bronchial obstruction or cardiac arrest, but also disseminated intervascular coagulation as well as adrenalin overdose [2, 7, 21, 31]. When anaphylactic reactions are survived, long-lasting sequels are rare. However,... 

HK it can interact with surface-bound factor XII on an adjacent particle thereby disseminating the reaction [25, 28]. As a result the effective kallikrein/factor XII ratio is increased in the presence of HK [25], Finally, in plasma, HK can displace other adhesive glycoproteins such as fibrinogen from binding to the surface [29]. In this sense, HK, like factor XII and prekallikrein, is also a coagulation cofactor because it is required for the generation of kalUkrein (a factor XII activator) as well as the activation of factor XI. 

Rhabdomyolysis, arrhythmias, seizures, and disseminated intravascular coagulation (DIC)... 

Poorly treated hyperthermia may lead to metabolic acidosis, rhabdomyolysis, elevated aminotransferases, seizures, renal failure, and disseminated intravascular coagulation (DIC)... 

TABLE 64-8. Conditions Associated with Disseminated Intravascular Coagulation... 

Francini M. Pathophysiology, diagnosis and treatment of disseminated intravascular coagulation An update. Clin Lab 2005 51(11—12) 633—639. 

Levi M, dejonge E, van der Pol T. Plasma and plasma components in the management of disseminated intravascular coagulation. Best Pract Res Clin Haematol 2006 19(1) 127-142. 

Disseminated intravascular coagulation is common in AML M3 and is associated with generalized bleeding or hemorrhage. 

CAPD Continuous ambulatory peritoneal dialysis DIC Disseminated intravascular coagulation... 

Pathological findings frequently observed in organs of patients who have died of sepsis include disseminated intravascular coagulation (DIC), manifested as diffuse thrombotic occlusions in the entire microvascular system, associated with alterations in the hemostatic mechanism and clinical signs of hemorrhagic diathesis. Many observations indicate that DIC contributes to the major symptoms of the systemic inflammatory response syndrome (SIRS), which frequently complicate sepsis (HI, H2, H3, T6). 

A9. Asakura, H., Jokaji, H., Saito, M Uotani, C., Kumabashiri, I., Morishita, E., Yamazaki, M and Matsuda, T., Plasma levels of soluble thrombomodulin increase in cases of disseminated intravascular coagulation with organ failure. Am. J. Hematol. 38,281-287 (1991). 

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