Disorders of coagulation or thrombosis - disseminated intravascular coagulation
Description
- Systemic intravascular coagulation activation - always secondary, never a primary diagnosis
- Simultaneous thrombosis and bleeding
- Microvascular fibrin deposition -> organ failure
- Consumption of platelets and factors + hyperfibrinolysis -> bleeding
- *Find and treat the trigger. Nothing else works.*
Two phenotypes - they behave differently
| Bleeding-dominant | Thrombotic / organ-failure-dominant | |
|---|---|---|
| Setting | APML, obstetric haemorrhage, trauma, aortic aneurysm, liver disease | Sepsis, malignancy (Trousseau), purpura fulminans |
| Driver | Hyperfibrinolysis predominates | PAI-1 suppresses fibrinolysis |
| Picture | Oozing, mucosal bleeding, low fibrinogen | Acral ischaemia, skin necrosis, AKI, ARDS |
- Chronic/compensated DIC - solid tumours, aortic aneurysm; normal or near-normal counts, high D-dimer, migratory thrombophlebitis
6 more sections, plus exam facts
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