弥散性血管内凝血22课件.ppt
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- 弥散 血管 凝血 22 课件
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1、Disseminated Intravascular CoagulationHuang HonghuiDept. of Hematology, Renji HospitalDefinitionDIC: clinicopathologic syndrome widespread intravascular coagulation is induced by procoagulants that are introduced into or produced in the blood circulation and overcome the natural anticoagulant mechan
2、isms.EtiologyStage of hypercoagulabilityStage of hypocoagulabilityStage of secondary fibrinolysisPathophysiologyStage of hypercoagulabilityStage of hypocoagulability due to excess of consumption of blood coagulation factorsStage of secondary fibrinolysisTyping of DICClinical featuresBleedingThromboe
3、mbolismCirculatory disturbance, shockMicroangiopathic hemolytic anemiaClinical featuresBleedingMechanismconsumption of hemostatic components including platelets, fibrinogen, and other coagulation factors;secondary fibrinolysis;anticoagulant effects of fibrinogen/fibrin degradation products;manifesta
4、tionsSkin and mucosa:petechiae, ecchymosis, oozing from veni-punctures, arterial lines, catheters, and injured tissues;internal organ:massive bleeding into the gastrointestinal, lungs, central nervous system, or orbit.Clinical featuresThromboembolism三、器官功能障碍DIC时,器官功能障碍主要由于微血栓大量形成!肺-呼吸功能障碍肾-肾功能障碍心-心泵
5、功能障碍肾上腺皮质-华-佛综合症垂体-席汉综合症心肌中的微血栓肝内微血栓肾 内 微 血 栓(纤 维 蛋 白 特 殊 染 色 )肺 泡肺 内 微 血 栓Clinical features Circulatory disturbance, shock a kininogen kallidini formation of Fibrinopeptide A microvascular thrombi Fibrinopeptide B thrombin dilatation of the blood vessles returned blood volume vasospasm hemorrhageSH
6、OCKcirculating blood volume diseases underlying DIC Clinical featuresMicroangiopathic hemolytic anemiaMechanismErythrocytes are injured mechanically during passage through fibrin networks in the microcirculation. Manifestationproduction of schistocytes and microspherocytes;jaundice, hemoglobinuria,
7、anemia.Direction ofblood flowFibrinRBC悬挂在纤维蛋白索上(扫描电镜,左2000,右5200)Laboratory featuresBasic blood examinationsPlatelet count: BPC Peripheral blood smear: schistocytes (in approximately 50% of cases)Laboratory featuresThe coagulation defectPartial thromboplastin time (PTT)Prothrombin timeThrombin timeF
8、ibrinogen concentrationLaboratory featuresTests for fibrinolysisFibrinogen degradation products (FDP)D-dimerPlasma protamine paracoagulation test (3P)Euglobulin lysis timeLaboratory featuresOther laboratory findings(molecular markers)F1+2Thrombin-AT complex (TAT)Fibrinopeptide A (FPA)SFMC (soluble f
9、ibrin monomer complex) Antithrombin Products of platelet activation:-TG,PF-4,TXB2,GMP-140PIC (plasmin-2 plasmin inhibitor complex) aprothrombin +AT TAT F1+2fibrinogenfibrin monomerFPA,FPBPolymerizationsoluble fibrinplasminaFDPcross-linked fibrinSFMC: FDP(X)+FM+FgLaboratory featuresLaboratory data ch
10、ange with remarkable rapidity in DIC, and in doubtful cases, it is often important to repeat the tests at frequent intervals, even every 8 to 12 hours and observing the dynamics of the process.Diagnostic criteria - ISTH DIC score1.Risk assessment: does the patient have an underlying disorder known t
11、o be associated with overt DIC?If yes: Proceed.If no: Do not use this algorithm.2. Order global coagulation testsplatelet count, prothrombin time,fibrinogen, fibrin-related marker3. Score global coagulation test results. Platelet count(100 = 0; 100 = 1; 50 = 2) Elevated fibrin related marker (e.g. D
12、-dimers; fibrin degradation products)(no increase = 0; moderate increase = 2; strong increase = 3) Prolonged prothrombin time( 3 but 6 s = 2) Fibrinogen level(1.0g/L = 0; 1.0g/L = 1)4. Calculate scoreIf 5: compatible with overt DIC: repeat score dailyIf 5: suggestive (not affirmative) for non-overt
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