Disseminated intravascular coagulopathy

Diarrhea is an early symptom and occurs only in 50% of cases. Intestinal hemorrhage or perforation, leukopenia, anemia, and subclinical disseminated intravascular coagulopathy may be seen. 

Anuria, disseminated intravascular coagulopathy Serious Reactions... 

A 65-year-old man, with metastatic carcinoma of the prostate was treated with flutamide 250 mg/day orally followed after 6 days by 7.5mg leuprolide intramuscularly. Two days later he developed bleeding and hematomas. His hemoglobin fell from 12.4 to 7.8 g/dl and he had a disseminated intravascular coagulopathy. 

An increased consumption of coagulation factors is found in extensive disseminated intravascular coagulopathy. Secondary hyperfibrinolysis evolves. Simultaneous activation of the coagulation cascade or fibrinolysis system leads to the consumption of coagulation factors as well as inhibitors. 

A 14-year-old girl, perinatally infected with HIV, had a medical history of recurrent infections that had been treated with several antibiotics, including ceftriaxone. She was given ceftriaxone (60 mg/kg intravenously) for pneumonia and 30 minutes later complained of severe back pain, became nauseated, vomited, and collapsed. Despite intensive medical care she died within a few hours with massive intravascular hemolysis and disseminated intravascular coagulopathy. Autopsy was refused. 

Jedeikin R, Olsfanger D, Kessler I. Disseminated intravascular coagulopathy and adult respiratory distress syndrome life-threatening comphcations of hysteroscopy. Am J Obstet Gynecol 1990 162(l) 44-5. 

Epoetin has been abused by athletes, increasing the risk of hypertension and disseminated intravascular coagulopathy (10). In athletes epoetin causes increased blood viscosity, which will further increase during dehydration, leading to risks of myocardial infarction, cerebrovascular accident, or encephalopathy (10). Epoetin induces accelerated fibrinolysis, and so epoetin doping can be detected by analysis of fibrin degradation products in urine (10). In addition, hypochromic macrocytes are increased (10). 

Although abnormalities in platelet aggregation have been described in healthy volunteers (21), coagulation disorders are not typical features in patients who receive G-CSF. Only one HIV-infected patient treated with zidovudine and increasing G-CSF doses had a disseminated intravascular coagulopathy (42). 

A 54-year-old man with rheumatoid arthritis for 12 years was given infliximab, with remission. He then developed a painful, confluent, erythematous, pustular rash over his trunk and limbs. Skin biopsy showed an acute pustular dermatitis. Five hours later he collapsed with a tachycardia (140/minute) and a blood pressure of 120/70 mmHg. He was apyrexial. His left leg was very tense, painful, and swollen, and he had a disseminated intravascular coagulopathy. There was marked necrosis of his adductor compartment and fascia of his left thigh and necrotic muscles were debrided. Blood cultures and skin swabs grew group A hemolytic streptococci. He then became unstable and died, despite efforts at resuscitation. 

Relative contraindications for prothrombin complex concentrate are liver disease, coronary heart disease, and factors that predispose to thrombosis (11). It is contraindicated in disseminated intravascular coagulopathy and hyperfibrinolysis. 

Ip M, Cheng KP, Cheung WC. Disseminated intravascular coagulopathy associated with rifampicin. Tubercle 1991 72(4) 291-3. 

Souza CS, Alberto FL, Foss NT. Disseminated intravascular coagulopathy as an adverse reaction to intermittent rifampin schedule in the treatment of leprosy. Int J Lepr Other Mycobact Dis 1997 65(3) 366-71. 

The hematological effects of tumor necrosis factor alfa mostly consist of dose-related thrombocytopenia and granulocytopenia, and decreased monocyte or lymphocyte counts (SED-13, 1111) (11,12). Septic episodes are sometimes associated with leukopenia. Coagulopathy with laboratory evidence of disseminated intravascular coagulopathy was found in 30% of patients and was sometimes associated with thromboembolic events (13). Other coagulation disorders include transient alterations in prothrombin time, and a rise in the plasma concentrations of von Willebrand factor was found in healthy volunteers (14). 

The effects of amphetamines on the kidney are mainly acute tubular necrosis on the basis of rhabdomyolysis (with myoglobinuria) and a disseminated intravascular coagulopathy. But, malignant hypertension and the resultant effects on the kidneys, must always be a consideration in the differential diagnosis of renal failure [45-50]. These effects are likely to be chronic and irreversible. Bingham et al reported a case of necrotising vasculopathy after the ingestion of... 

Acute cocaine toxicity produces a sympathomimetic response that may result in mydriasis, diaphoresis, hyperactive bowel sounds, tachycardia, hypertension, hyperthermia, hyperactivity agitation, seizures, or coma. Sudden death due to cardiotoxicity may occur following cocaine use. Death may also occur following the sequential development of hyperthermia, agitated delirium, and respiratory arrest. Excited delirium and extreme physical activity may lead to rhabdomyolysis, acute renal failure, and disseminated intravascular coagulopathy. 

Systemic illness may occur in the first 24-48 hours and does not necessarily correlate with the severity of the ulcer. Systemic manifestations include fever, chills, malaise, nausea, and myalgias. Rarely, intravascular hemolysis and disseminated intravascular coagulopathy may occur. 

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