DIC-Syndrome: Treatment and Diagnosis
Mar 19, 2018
The syndrome of disseminated intravascular coagulation( ICD) is one of the most serious complications of a variety of diseases.This is a real headache for any resuscitator, since a patient in this condition can die at any time.It develops quite quickly, the treatment is not easy, the prognosis for life at its appearance becomes rather unfavorable.Table of Contents: Definition Causes of DIC Syndrome Symptoms of DIC Syndrome Diagnosis of DIC Syndrome Treatment of DIC Syndrome Prevention
DIC is a pathological condition that develops as a result of the depletion of factors contributing to and counteracting blood coagulation.The basis of this process is the blockade of small vessels with loose blood clots that result from the release of a large number of coagulation factors into the blood( hypercoagulation).The remaining blood in the bloodstream loses its ability to coagulate because of the reduction in the number of clotting factors, the activation of substances that dissolve clots, the accumulation of decay products of proteins that have anticoagulant activity.
Causes of the DIC-
A number of severe and critical conditions can cause the DIC syndrome.Practically any pathology at which there is damage to the vascular wall, a change in the properties of the blood, the rate of its flow through the vessels, can trigger a cascade of reactions leading to intravascular coagulation. The main causes of the disease are as follows:
- Any form of shock.In this condition, a serious deterioration in the rheological properties of the blood( increase in its viscosity) is noted, as well as damage to the wall of small vessels.
- Severe septic infections.In this case, the mechanism of intravascular coagulation can be triggered directly by bacterial toxins or indirectly through the destruction of the endothelium( inner shell) of the vessels by microorganisms and the products of their vital activity.
- Hemolysis( massive destruction of erythrocytes).It arises as a result of transfusion of incompatible or overdue blood, with heavy physical exertion, severe supercooling, changes in atmospheric pressure, and also taking certain medicines( quinidine, nitrofuran and sulfanilamide chemotherapy).
- Syndrome of massive transfusions.The volume of transfusion over 5 liters can become the starting factor of DIC syndrome.Necrosis in various organs.
- .Myocardial infarction, acute cerebrovascular accident( stroke), some forms of pancreatitis, acute liver dystrophy, skin and mucous membrane burns, massive surgical interventions and injuries, crash syndrome( or long-term compression syndrome) all lead to a powerful release into the bloodstreamCalled a tissue factor - the main substance that triggers the cascade of hypercoagulation reactions.
- Immune and immunocomplex diseases.
- Tumor process, especially with multiple metastases.
- Hemodialysis, hemosorption, extracorporeal circulation( eg, in cardiac surgery).
- Acute poisoning with hemolytic poisons.
- Obstetrical pathology.This includes many situations that arise during pregnancy and childbirth - gestosis, placenta previa, early discharge of amniotic fluid, early placental abruption, intrauterine fetal death).
Symptoms of DIC-
Symptomatic of this pathology depends on the stage of the disease development, as well as the form of the syndrome - acute or chronic. In stages, the clinical picture of an acute DIC syndrome may be as follows:
- The stage of hypercoagulation, during which there is a massive formation of thrombi in blood vessels of small diameter.The duration of this stage is very small, and the clinical picture is usually masked by the symptoms of a severe underlying disease.
- The stage of hypocoagulation is the period of the first bleeding.In this phase, the factors that prevent coagulation are activated and the coagulation enhancing factors are at the same time exhausted.As a result, the main clinical sign of DIC syndrome is a variety of bleeding.Distinguish:
- Early bleeding that occurs mainly in the place where the tissues were destroyed: in case of abortions or childbirth - uterine, in surgical interventions - in the zones of incisions, with destructive processes in the lungs - respectively pulmonary.In parallel, the appearance of hemorrhages and other localizations - subcutaneous, submucosal, intradermal at the injection site.
- Late bleeding is a manifestation of worsening of the patient's condition.It can be nasal and gastrointestinal bleeding, the appearance of hematomas in the subcutaneous fat, in the buttocks, waist, etc.
- In the subsequent stages, along with bleeding, symptoms of functional and then organic failure of the affected organs increase,And the organs that penetrate the rich capillary network first of all suffer: adrenals, kidneys, lungs, liver, gastrointestinal tract, spleen, skin, mucous membranes.
Chronic DVS-syndrome is usually manifested by thrombosis and thromboembolism localized in various organs.This form of pathology is most often found in people suffering from cancer malignant neoplasms.Deep vein thrombosis, turning into thromboembolism of the pulmonary artery - one of the most common causes of death of patients with tumors.
Diagnosis of DIC-
Clinical diagnosis of DIC syndrome at an early stage is very complicated: the symptoms are meager, bleeding is not available, and its term is very short.With the depletion of blood coagulation factors and the appearance of hemorrhages, the diagnosis of pathology can be set with a fairly high certainty.And the more time has passed since the first bleeding, the easier it is to detect the DIC syndrome.The balance of expectant tactics is the rapid deterioration in the prognosis of the disease. For this reason, a number of analyzes showing the state of the coagulation system are made urgently by the patients:
- blood clotting time, which, being normal or even truncated in the hypercoagulable stage, progressively lengthens with the development of the disease( up to 30 minutes or more);
- the number of platelets in the peripheral blood, which gradually decreases relative to normal;
- thrombin time, increasing depending on the stage from normal 5-11 seconds to 60 or more;
- analysis for D-dimers, normally absent, but with intravascular coagulation - sharply elevated.
Other assays are also used in practice, but additional information important for diagnosis is not given.
A specialist in the treatment of a patient must clearly know all the ways of diagnosing the DIC syndrome and their results, since the tactics of medical measures depend on the correct definition of the stage of the process.
Treatment of DIC-
Treatment of the underlying disease - the main thing that you need to do when fighting with intravascular coagulation.If you do not eliminate the cause of the complication - it will be impossible to get rid of it.Therefore, rational antibiotic therapy for infections, adequate hemostasis for injuries of any nature, detoxification during poisoning can lead even to the spontaneous disappearance of DIC syndrome.
If, however, spontaneous regression does not occur, the pathology must be immediately addressed.Treatment of the disease is carried out, given its stage:
- 1st stage.It is necessary to prevent hypercoagulation by the use of heparin, intravenous infusions of rheopolyglucin in combination with disaggregants, the administration of corticosteroids.
- 2nd stage.To the above preparations, intravenous infusion of albumins, freshly frozen plasma, whole blood or erythrocyte mass is added.
- 3rd stage.In this phase, the approach to treatment changes dramatically, since here the activity of a system that prevents blood clotting comes to the fore.Apply drugs that inhibit the activity of anti-coagulation factors( gordoks, kontrikal), enhancing the work of platelets( etamzilate).In parallel with this, the system of clotting is sought to activate by infusion of plasma.With reduced hemoglobin, whole blood is also poured in small amounts.The administration of heparin is discontinued.
- 4th stage.At this stage, the activities are the same as in the third stage with the addition of solutions based on albumin, gelatin.
In parallel with these actions, correction of water-electrolyte and acid-alkaline conditions is carried out, normalizes kidney function, supports respiratory functions, and compensates for blood loss.
Knowledge of the causes of DIC-Syndrome makes possible and measures to prevent .Of course, everything can not be foreseen, but compliance with several rules can seriously reduce the risk of developing this severe pathology:
- , if necessary, surgical treatment - choosing the most gentle procedure of surgery;
- use of anticoagulants in any pathology that can be complicated by an ICE syndrome;
- Avoiding bites of snakes and intoxications by chemicals;
- failure or minimal use of whole blood in favor of its derivatives( erythrocyte mass, plasma) and plasma substitutes;
- early detection and treatment of cancer.
The DIC syndrome is an exceptionally severe complication of clinical pathology, characterized by very high lethality - depending on the cause, up to 50% of patients die.That is why prevention measures can be considered even more important than medical measures.The English have one proverb: "It is better than an ounce of prevention than a pound of treatment," and it can not be better suited for disseminated intravascular coagulation.
Bozbey Gennady Andreevich, ambulance doctor