Disseminated intravascular coagulation

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Disseminated intravascular coagulation

Hematological system

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Disseminated intravascular coagulation

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Hematological system pathology review

Microcytic anemia: Pathology review

Non-hemolytic normocytic anemia: Pathology review

Intrinsic hemolytic normocytic anemia: Pathology review

Extrinsic hemolytic normocytic anemia: Pathology review

Macrocytic anemia: Pathology review

Heme synthesis disorders: Pathology review

Coagulation disorders: Pathology review

Platelet disorders: Pathology review

Mixed platelet and coagulation disorders: Pathology review

Thrombosis syndromes (hypercoagulability): Pathology review

Lymphomas: Pathology review

Leukemias: Pathology review

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Assessments

Disseminated intravascular coagulation

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USMLE® Step 1 questions

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Flashcards

Disseminated intravascular coagulation

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Questions

USMLE® Step 1 style questions USMLE

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A 4-year-old girl presents to the emergency department with abdominal pain, diarrhea, and fatigue. The patient was in her usual state of health until yesterday afternoon, when her family returned home from a barbeque. The patient is otherwise healthy and takes no medications aside from amoxicillin for a recent episode of otitis media. According to her parents, the patient’s urine has looked “darker” than usual. Temperature is 39.0°C (102.2°F), pulse is 115/min, respirations are 22/min, and blood pressure is 100/70 mmHg. Physical examination demonstrates a pale appearing girl with diffuse abdominal tenderness to palpation, delayed capillary refill, and gingival bleeding. Multiple tiny, brownish-purple, blanchable spots are noted under the skin. Which of the following laboratory findings are most consistent with this patient’s disease process?  

External References

First Aid

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Disseminated intravascular coagulation (DIC) p. 435

acute myelogenous leukemia p. 440

amniotic fluid emboli p. 697

Ebola p. NaN

endotoxins p. 129, 131

meningococci p. 140

microangiopathic anemia p. 417

placental abruption p. 664

schistocytes in p. 424

Waterhouse-Friderichsen syndrome p. 355, 716

Transcript

Content Reviewers

Rishi Desai, MD, MPH

Contributors

Tanner Marshall, MS

Disseminated intravascular coagulation, or DIC, describes a situation in which the process of hemostasis, which is when after blood vessel wall injury, liquid blood rapidly becomes a gel, called coagulation or clotting, starts to run out of control.

When this happens, lots and lots of blood clots start to form in blood vessels serving various organs, leading to organ ischemia.

DIC, though, is also called a consumption coagulopathy, because all this clotting consumes platelets and clotting factors.

Without enough platelets circulating in the blood, other parts of the body begin to bleed with even the slightest damage to the blood vessel walls. So paradoxically, patients have too much and too little clotting.

Normally, after a cut and damage to the endothelium, or inner lining of blood vessel walls, there’s an immediate vasoconstriction or narrowing of the blood vessel which limits the amount of blood flow.

After that, some platelets adhere to the damaged vessel wall, and become activated and then recruit additional platelets to form a plug.

The formation of the platelet plug is called primary hemostasis.

After that, the coagulation cascade is activated. First off in the blood there’s a set of clotting factors, most of which are proteins synthesized by the liver, and usually these are inactive and just floating around in the blood.

The coagulation cascade starts when one of these proteins gets proteolytically cleaved.

This active protein then proteolytically cleaves and activates the next clotting factor, and so on.

Sources

  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "How I treat disseminated intravascular coagulation" Blood (2018)
  5. "Diagnosis and management of sepsis‐induced coagulopathy and disseminated intravascular coagulation" Journal of Thrombosis and Haemostasis (2019)
  6. "Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies" Clinical and Applied Thrombosis/Hemostasis (2018)
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