Intravascular Coagulation

Cytokines, eg, interferons, interleukins, tumor necrosis factor (TNF), and certain growth factors, could have antitumor activity directiy, or may modulate cellular mechanisms of antitumor activity (2). Cytokines may be used to influence the proliferation and differentiation of T-ceUs, B-ceUs, macrophage—monocyte, myeloid, or other hematopoietic cells. Alternatively, the induction of interferon release may represent an important approach for synthetic—medicinal chemistry, to search for effective antiinflammatory and antifibrotic agents. Inducers of interferon release may also be useful for lepromatous leprosy and chronic granulomatous disease. The potential cytokine and cytokine-related therapeutic approaches to treatment of disease are summarized in Table 4. A combination of cytokines is a feasible modaUty for treatment of immunologically related diseases however, there are dangers inherent in such an approach, as shown by the induction of lethal disserninated intravascular coagulation in mice adrninistered TNF-a and IFN-y. 

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. 

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). 

Thrombomodulin. In patients with SIRS and DIC due to sepsis the serum soluble TM level was higher than in nonseptic and non-DIC patients (A9, B32, G3, II, K7). In experimental ARDS in rats induced by LPS, administration of soluble recombinant TM inhibited the occurrence of intravascular coagulation and prevented the increase in pulmonary vascular permeability (Ul). 

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). 

G3. Gando, S., Kameue, T., Nanzaki, S and Nakanishi, Y., Cytokines, soluble thrombomodulin and disseminated intravascular coagulation in patients with systemic inflammatory response syndrome. Thomb. Res. 80,519-526 (1995). 

H2. Haanen, C Disseminated intravascular coagulation and its impact on blood transfusion. In Blood Transfusion and Problems of Bleeding (C.Th. Smit Sibinga, P. C. Das, J. J. van-Loghem, eds.), Martinus Nijhoff, The Hague, 133-145 (1982). 

K5. Kawamura, M Terashita, Z Imura, Y., Shino, A., and Nishikawa, K Inhibitory effect of TCV-309, a novel platelet activating factor (PAF) antagonist, on endotoxin-induced disseminated intravascular coagulation in rats Possible role of PAF in tissue factor generation. Thromb. Res. 70,281-293(1993). 

Ono, S Mochizuki, H., and Tamakuma, S A clinical study on the significance of platelet-activating factor in the pathophysiology of septic disseminated intravascular coagulation in surgery. Am. J. Surg. 171,409-415 (1996). 

Ou, M. C., Kambayashi, J., Kawasaki, T., Ueraura, Y., Shinozaki, K., Shiba, E Sakon, M Yukawa, M and Mori, T Potential etiologic role of PAF in two major septic complications disseminated intravascular coagulation and multiple organ failure. Thromb. Res. 73, 227-238 (1994). 

Suggested Alternatives for Differential Diagnosis Scarlet fever, cellulitis, cat scratch disease, gas gangrene, necrotizing fasciitis, tick-borne diseases such as Rocky Mountain spotted fever, pneumonia, septic shock, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation. 

Suggested Alternatives for Differential Diagnosis Malaria, typhoid fever, shigellosis, meningococcemia, salmonella infection, other tick-borne diseases, rickettsial infections, leukemia, lupus, disseminated intravascular coagulation, hemolytic uremic syndrome, leptospirosis, thrombocytopenic purpura, and idiopathic or thrombotic thrombocytopenic purpura. 

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