Definition
Disseminated intravascular coagulation (CID) is a syndrome characterized by an abnormal activation of the blood coagulation process, capable of causing an uncontrolled generation of thrombin and fibrin in the circulating blood.
This condition is secondary to various disease states, including sepsis, obstetric complications (such as abruptio placentae, retention of products of conception and embolism of amniotic fluid), haematological malignancies (including acute leukemias and lymphomas), liver diseases (eg fulminant hepatitis ) and extensive tissue damage (burns, hyperthermia, crushing trauma and rhabdomyolysis).
Less frequent causes of disseminated intravascular coagulation include large vessel aneurysms, severe haemolysis and cavernous hemangiomas (Kasabach-Merritt syndrome) associated with damage to the vascular wall and areas of blood stasis.
Disseminated intravascular coagulation may be of extreme severity (acute CID) or manifest as sub-clinical or chronic disorder. During the blood coagulation process, widespread thrombotic phenomena occur due to increased platelet aggregation and consumption of coagulation factors.
Most common symptoms and signs *
- Anemia
- Asthenia
- Chills
- palpitations
- Muscle cramps
- Dyspnoea
- Abdominal pain
- Bruising
- Edema
- Gastrointestinal hemorrhage
- Ease of bleeding and bruising
- Sore legs
- Hypotension
- Metrorrhagia
- Nausea
- Pallor
- petechiae
- thrombocytopenia
- Nosebleeds
- Blood in the urine
- Bleeding gums
- tachypnoea
- He retched
Further indications
The clinical onset varies according to the underlying pathology and the rapidity with which coagulopathy is established. A disseminated intravascular coagulation that evolves slowly (in weeks or months; chronic CID ) causes venous thromboembolic manifestations (eg deep vein thrombosis, pulmonary embolism, etc.); when it evolves rapidly (in hours or days; acute CID ), on the other hand, it is mainly a haemorrhagic symptom that is difficult to control. In the latter case, bleeding is persistently associated with microvascular thrombosis, which can cause dysfunction in multiple districts and a state of multi-organ failure.
The symptomatology of disseminated intravascular coagulation also includes cutaneous-mucosal hemorrhagic manifestations with extensive ecchymoses (apparently spontaneous or from venopuncture) and petechiae. Epistaxis, gingivorrhea, hematuria and metrorrhagia are frequent. Disseminated intravascular coagulation can also lead to metabolic acidosis, respiratory failure and general gastrointestinal and renal symptoms.
Disseminated intravascular coagulation is diagnosed by demonstrating the significant alterations of some laboratory parameters: thrombocytopenia, prolongation of prothrombin time (PT) and partial thromboplastin time (PTT), increase in plasma levels of fibrin degradation products and reduction in plasma fibrinogen .
The treatment consists primarily of correcting the triggering cause (in sepsis, for example, aggressive and rapid effect antibiotic therapy is required). The therapy also provides for the replacement of platelets and coagulation factors lacking with the infusion of fresh concentrated plasma and fibrinogen with cryoprecipitate in order to control severe bleeding. Heparin is used as therapy in patients with chronic disseminated intravascular coagulation who have venous thromboembolism or as prophylaxis in anticipation of surgery or upcoming chemotherapy treatments.
