Disseminated intravascular coagulation - Revision history

ClaireLewis at 00:24, 1 October 2019

2019-10-01T00:24:11Z

← Revisión anterior		Revisión del 00:24 1 oct 2019
Línea 15:		Línea 15:
	*[[Trauma]]		*[[Trauma]]
	*[[Pancreatitis]]		*[[Pancreatitis]]
	**Brain injury, [[crush injury]], [[burns]], [[rhabdomyolysis]], fat embolism		**Brain injury, [[crush injury]], [[burns]], [[rhabdomyolysis]], [[fat embolism]]
	*Liver disease		*[[hepatic failure\|Liver disease]]
	*Pregnancy-related		*[[Pregnancy]]-related
	**[[Placental Abruption]], [[Amniotic Fluid Embolus]], [[septic abortion]], [[HELLP Syndrome]], [[acute fatty liver of pregnancy]]		**[[Placental Abruption]], [[Amniotic Fluid Embolus]], [[septic abortion]], [[HELLP Syndrome]], [[acute fatty liver of pregnancy]]
	*[[Snake bite]]		*[[Snake bite]]
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	==Clinical Features==		==Clinical Features==
	''Bleeding or thrombosis can predominate (bleeding is more common ~65%)''		''[[hemorrhage\|Bleeding]] or [[thromboembolism\|thrombosis]] can predominate (bleeding is more common ~65%)''
	*~~Shock~~ (15%)		*[[Shoc]]k (15%)
	*[[Acute renal failure]] (25-40%)		*[[Acute renal failure]] (25-40%)
	*Hepatic dysfunction (19%)		*[[hepatic failure\|Hepatic dysfunction]] (19%)
	*Respiratory dysfunction (16%)		*Respiratory dysfunction (16%)
	*[[Thromboembolism]] (7%)		*[[Thromboembolism]] (7%)
	*CNS involvement (2%)		*CNS involvement (2%)
	*Purpura fulminans (widespread arterial and venous thromboses)		*[[Purpura fulminans]] (widespread arterial and venous thromboses)
	**Associated with significant bacteremia		**Associated with significant [[bacteremia]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	===Acute===		===Acute===
	*Platelets<ref>Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost. 1980 Feb 29. 43(1):28-33.</ref>		*Platelets<ref>Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost. 1980 Feb 29. 43(1):28-33.</ref>
	**Low (or dropping) in 98% of DIC patients		**[[thrombocytopenia\|Low]] (or dropping) in 98% of DIC patients
	**Sn, not Sp		**Sn, not Sp
	**Repeat platelets may be necessary if first level normal or if need to trend		**Repeat platelets may be necessary if first level normal or if need to trend
	*PT and PTT		*PT and PTT
	**Prolonged		**[[coagulopathy\|Prolonged]]
	**May be normal in as many as 50% of DIC patients<ref>Olson JD, Kaufman HH, Moake J, O'Gorman TW, Hoots K, Wagner K, et al. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989 Jun. 24(6):825-32.</ref>		**May be normal in as many as 50% of DIC patients<ref>Olson JD, Kaufman HH, Moake J, O'Gorman TW, Hoots K, Wagner K, et al. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989 Jun. 24(6):825-32.</ref>
	**Serial coagulation testing may be necessary		**Serial coagulation testing may be necessary

ClaireLewis: /* Causes */

2019-08-23T19:23:08Z

Causes

← Revisión anterior		Revisión del 19:23 23 ago 2019
Línea 18:		Línea 18:
	*Liver disease		*Liver disease
	*Pregnancy-related		*Pregnancy-related
	**[[Placental Abruption]], [[Amniotic Fluid Embolus]], [[septic abortion]], [[HELLP Syndrome]]		**[[Placental Abruption]], [[Amniotic Fluid Embolus]], [[septic abortion]], [[HELLP Syndrome]], [[acute fatty liver of pregnancy]]
	*[[Snake bite]]		*[[Snake bite]]
	*[[ARDS]]		*[[ARDS]]

Ostermayer: /* Clinical Features */

2019-05-12T03:24:21Z

Clinical Features

← Revisión anterior		Revisión del 03:24 12 may 2019
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	==Clinical Features==		==Clinical Features==
	''~~In given patient either bleeding~~ or thrombosis ~~will~~ predominate (bleeding is more common ~65%)''		''Bleeding or thrombosis can predominate (bleeding is more common ~65%)''
	*Shock (15%)		*Shock (15%)
	*[[Acute renal failure]] (25-40%)		*[[Acute renal failure]] (25-40%)

ClaireLewis: /* Causes */

2016-12-11T01:01:11Z

Causes

← Revisión anterior		Revisión del 01:01 11 dic 2016
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	*Carcinoma		*Carcinoma
	*[[Leukemia]]		*[[Leukemia]]
	*Trauma		*[[Trauma]]
	*Pancreatitis		*[[Pancreatitis]]
	**Brain injury, crush injury, burns, [[rhabdomyolysis]], fat embolism		**Brain injury, [[crush injury]], [[burns]], [[rhabdomyolysis]], fat embolism
	*Liver disease		*Liver disease
	*Pregnancy		*Pregnancy-related
	**[[Placental Abruption]], [[Amniotic Fluid Embolus]], septic abortion, [[HELLP Syndrome]]		**[[Placental Abruption]], [[Amniotic Fluid Embolus]], [[septic abortion]], [[HELLP Syndrome]]
	*[[Snake bite]]		*[[Snake bite]]
	*[[ARDS]]		*[[ARDS]]
	*[[Transfusion reaction]]		*[[Transfusion reaction]]
	*Transplant rejection		*[[Transplant complications\|Transplant rejection]]

	==Clinical Features==		==Clinical Features==

Alvarez13 at 01:38, 6 December 2016

2016-12-06T01:38:32Z

← Revisión anterior		Revisión del 01:38 6 dic 2016
Línea 10:		Línea 10:

	===Causes===		===Causes===
	*~~Infection~~ (most common cause)		*[[Sepsis]](most common cause)
	*Carcinoma		*Carcinoma
	*Leukemia		*[[Leukemia]]
	*Trauma		*Trauma
			*Pancreatitis
	**Brain injury, crush injury, burns, [[rhabdomyolysis]], fat embolism		**Brain injury, crush injury, burns, [[rhabdomyolysis]], fat embolism
	*Liver disease		*Liver disease
	*Pregnancy		*Pregnancy
	**Abruption, [[Amniotic Fluid Embolus]], septic abortion, HELLP ~~syndrome~~		**[[Placental Abruption]], [[Amniotic Fluid Embolus]], septic abortion, [[HELLP Syndrome]]
	*[[Snake bite]]		*[[Snake bite]]
	*[[ARDS]]		*[[ARDS]]
	*[[Transfusion reaction]]		*[[Transfusion reaction]]
			*Transplant rejection

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: Text replacement - "rhabdo" to "rhabdomyolysis"

2016-08-01T11:43:09Z

Text replacement - "rhabdo" to "rhabdomyolysis"

← Revisión anterior		Revisión del 11:43 1 ago 2016
Línea 14:		Línea 14:
	*Leukemia		*Leukemia
	*Trauma		*Trauma
	**Brain injury, crush injury, burns, [[~~rhabdo~~]], fat embolism		**Brain injury, crush injury, burns, [[rhabdomyolysis]], fat embolism
	*Liver disease		*Liver disease
	*Pregnancy		*Pregnancy

Rossdonaldson1: /* Differential Diagnosis */

2016-07-23T16:48:56Z

Differential Diagnosis

← Revisión anterior		Revisión del 16:48 23 jul 2016
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	==Differential Diagnosis==		==Differential Diagnosis==
	*Severe liver disease
	**Also associated with prolonged PT/PTT, thrombocytopenia, elevated D-dimer, elevated FDPs
	***However, D-dimer is usually only mildly elevated

	{{Hemolytic anemia DDX}}		{{Hemolytic anemia DDX}}

	{{Thrombocytopenia}}		{{Thrombocytopenia}}

	{{Increased bleeding DDX}}		{{Increased bleeding DDX}}
			{{Bullous rashes DDX}}

	==Evaluation==		==Evaluation==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T07:02:35Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 07:02 23 jul 2016
Línea 44:		Línea 44:
	{{Increased bleeding DDX}}		{{Increased bleeding DDX}}

	==~~Diagnosis~~==		==Evaluation==
	===Acute===		===Acute===
	*Platelets<ref>Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost. 1980 Feb 29. 43(1):28-33.</ref>		*Platelets<ref>Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost. 1980 Feb 29. 43(1):28-33.</ref>

ClaireLewis: /* Management */

2016-07-14T05:05:35Z

Management

← Revisión anterior		Revisión del 05:05 14 jul 2016
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	****Consider repletion with [[cryoprecipitate]] to raise level to 100-150		****Consider repletion with [[cryoprecipitate]] to raise level to 100-150
	***[[Platelets]]		***[[Platelets]]
	****Consider repletion if <50K w/ bleeding or <20K without bleeding		****Consider repletion if <50K with bleeding or <20K without bleeding
	***[[FFP]]		***[[FFP]]
	****Consider repletion to goal of PT and PTT < 1.5 times the normal limit		****Consider repletion to goal of PT and PTT < 1.5 times the normal limit

ClaireLewis: /* Acute */

2016-07-14T05:05:17Z

Acute

← Revisión anterior		Revisión del 05:05 14 jul 2016
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	*Fibrinogen		*Fibrinogen
	**Low		**Low
	**<100 correlates w/ severe DIC		**<100 correlates with severe DIC
	**May be normal (acute phase reactant), up to 57% in DIC patients<ref>Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost. 1980 Feb 29. 43(1):28-33.</ref>		**May be normal (acute phase reactant), up to 57% in DIC patients<ref>Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost. 1980 Feb 29. 43(1):28-33.</ref>
	*FDP		*FDP
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	*[[D-dimer]]		*[[D-dimer]]
	**Elevated		**Elevated
	**Sn but not Sp: may also see in patients w/ chronic liver or renal disease		**Sn but not Sp: may also see in patients with chronic liver or renal disease
	**Combination of elevated FDP and d-dimer may increase sensitivity and specificity		**Combination of elevated FDP and d-dimer may increase sensitivity and specificity
	*RBCs		*RBCs