DIC is a disorder of hemostasis processes, which contributes to the formation of blood clots, and in addition, the development of various microcirculatory and hemorrhagic disorders. The full name of this disease sounds like disseminated intravascular coagulation, in addition, there is such a designation of the pathology as thrombohemorrhagic syndrome. Next, we will find out how this disease is treated and how it is diagnosed.
Basic information about the disease
This syndrome is characterized by hemorrhagic diathesis with increased blood coagulation inside the vessels. This leads to the formation of blood clots. These processes entail the development of pathological changes in the organs of a dystrophic, hypoxic and necrotic nature.
DIC implies a threat to the life of the patient, as there is a risk of bleeding. They can be extensive and difficult to stop. ATpathological processes can also involve internal organs, whose functioning is completely disrupted. The kidneys, spleen, lungs, liver and adrenal glands are primarily at risk.
Many are wondering what causes DIC.
This ailment can occur in various diseases, but absolutely always leads to thickening and disruption of blood circulation through the capillaries. Such a process is incompatible with the normal functioning of the organism. DIC can lead to a lightning death of a person or to a protracted latent fatal form of disorders.
The statistics of this syndrome is difficult to calculate, since it occurs with different frequency in certain diseases. Some diseases are always accompanied by this syndrome, while in other diseases it is much less common.
For DIC, the protocol for diagnosis and treatment will be presented below.
This pathology should be regarded as an abnormal protective reaction of the body, which is issued to them in order to be able to suppress the bleeding that occurs when the vessels are damaged. So the body tries to protect itself from tissue damage. This disease is very common in medical practice of various speci alties. Resuscitators, gynecologists, traumatologists, surgeons and hematologists are very familiar with this syndrome.
Let's consider the pathogenesis of DIC.
What happens?
This marks the failure of the body's responses that are triggered to try to prevent bleeding. Such a process is calledhemostasis. Against this background, the function that is responsible for blood clotting is excessively stimulated, and the fibrinolytic and anticoagulant systems that balance it, on the contrary, are very quickly depleted.
Enzymes that are produced by toxins, bacteria, immune complexes, phospholipids and so on that have entered the body can affect the manifestation of this syndrome. At the same time, they circulate in the bloodstream or affect the vascular endothelium.
Stages of disease
The syndrome usually develops according to some specific patterns, passing through a series of successive stages:
- At the first stage, the process of excessive blood coagulation is triggered, as well as cell aggregation inside the vessels. An excess amount of thromboplastin or substances that have a similar effect are released into the blood. These processes trigger the rollup. The period of the initial stage varies greatly, taking from a minute to a couple of hours if the syndrome develops in an acute form. Up to several months, pathological processes can occur if the syndrome is chronic.
- The second stage of DIC is characterized by the launch of consumption coagulopathy processes. Against this background, the lack of platelets, fibrogen and other plasma factors that are responsible for blood coagulation processes increases in the body.
- The third stage of DIC is already considered critical. During this period, the process of secondary fibrinolysis occurs, and blood coagulationreaches its maximum until the process stops completely. Against this background, hemostasis is significantly unbalanced.
- The recovery stage is characterized by the normalization of hemostasis. Residual dystrophic and necrotic changes are observed on tissues and organs. Another culmination of this syndrome can be an acute failure of a particular organ.
The full development of the disease, that is, its severity, and the mechanism of development largely depend on the degree of microcirculation disorders and the level of damage to organs and systems.
One of the causes of acute DIC during pregnancy at any gestational age is intrauterine fetal death and fading of pregnancy. Pathology of the 4th degree can lead to the death of a woman, therefore, with any signs indicating a possible termination of pregnancy, you must immediately contact the department of labor pathology at the district maternity hospital.
The causes of DIC in obstetrics may be of infectious origin. Infection of the amniotic waters, prolonged bacterial infections of the mother's internal organs, which increase the risk of bacteria and their toxins entering the bloodstream - all this can cause clotting disorders and systemic coagulopathy, so it is important to treat any diseases of an infectious nature in time and follow all doctor's prescriptions.
The danger of DIC in obstetrics lies in its almost asymptomatic course. In most cases, pathology can only be determinedafter laboratory diagnostics, which can determine hematological disorders (changes in blood chemistry).
In children
DIC in newborns can be triggered by the following reasons:
- damage to the "children's seat";
- intrauterine death of one of the children in multiple pregnancies;
- intrauterine infection;
- eclampsia and preeclampsia condition;
- uterine rupture;
- bubble skid.
Most often, pathology is diagnosed in premature babies. The child's blood contains insufficient amounts of procoagulants or anticoagulants, which causes increased bleeding.
DIC in an infant can develop with many illnesses. The condition typically has a fulminant course, which virtually eliminates the possibility of any treatment.
Complications
They are usually very severe against the background of this disease and can threaten not only he alth, but also life. More often than others, these patients tend to develop the following diseases and conditions:
- Development of hemocoagulation shock. Against the background of it, tissues and organs in a person begin to experience oxygen deficiency, since blood microcirculation is disturbed in the vessels that are responsible for their nutrition. In addition, the amount of toxins directly in the blood itself is extremely exceeded. As a result, the patient's pressure drops sharply, shock and organ failure join.
- Development of acuterespiratory failure in DIC. This condition is borderline and poses a direct threat to the patient's life. With increased hypoxia, consciousness may be lost, convulsions occur, and as a result, hypoxic coma sets in.
- The development of acute kidney failure is another very common complication of this syndrome. The patient stops urinating, urine output stops. The water-s alt balance is also disturbed, and the level of nitrogen, urea and creatinine increases in the blood. But such a condition is classified as potentially reversible.
- Development of liver necrosis.
- The digestive system can be marked by the appearance of stomach ulcers, intestinal infarction, pancronecrosis, and so on.
- Ischemic stroke is possible from the side of the work of the heart.
- The hematopoietic system reacts with acute hemorrhagic anemia.
Next, we will find out what research methods are used to diagnose this pathology.
Diagnostics
Diagnosis of the disease is built by the doctor when examining the patient, and in addition, as part of the collection of anamnesis and various laboratory tests. Diagnosis assumes:
- Performing a clinical blood test.
- Clinical urinalysis study.
- Blood smear examination.
- Donating blood for a coagulogram. This study is the main method for diagnosing hemostasis, within which fibrogens, platelets and other important indicators are counted.
- Enzyme immunoassay, which examines the main markers of blood coagulation inside blood vessels.
- Donating blood for paracoagulation tests allows you to refute or, conversely, confirm the diagnosis.
Thanks to all these studies, doctors find out the root cause that led to the syndrome. In addition, based on these tests, the stage and nature of the disease is determined.
Diagnosis of DIC should be timely.
In the event that the course of the syndrome is latent, then it will be possible to determine hypercoagulability solely on the basis of laboratory tests. Against this background, fragmented erythrocytes will be observed in the smear, thrombosed time will increase, and the concentration of fibrin degradation products will increase significantly. A blood test will indicate a lack of fibrinogen and platelets in it. When the syndrome is confirmed, the most vulnerable organs, such as the kidneys, heart, lungs, liver, brain and adrenal glands, are necessarily examined.
What are the recommendations for DIC?
Treatment
Treatment of this disease is a rather complicated process, the recovery of the patient may not occur in every situation. In the event that an acute form of the course of the disease was diagnosed, then death occurs in thirty percent of cases, which is considered a fairly high rate. But nevertheless, it is far from always possible to establish exactly the cause of the death of the patient. It is not always immediately clear whether this syndrome servedcritical condition, or the patient died due to the negative impact of their underlying disease.
Doctors who observe DIC-syndrome of the blood, make their efforts in the first place to eliminate or at least minimize the factors that led to the development of the syndrome and stimulate its progression. First of all, it is important to be able to eliminate the purulent-septic condition, which most often provokes violations of hemostasis. Against this background, it makes no sense to wait for the result of a bacteriological study, therapy is carried out in accordance with the clinical manifestations of the disease.
Clinical guidelines for DIC should be strictly followed.
When is antibiotic therapy indicated?
Antibacterial therapy is prescribed in some of the following cases:
- As a result of an abortion.
- Against the background of premature discharge of amniotic fluid, especially if they are not transparent and contain turbidity.
- Temperature increase.
- Presence of symptoms that indicate inflammation of the lungs, abdominal organs or urinary tract.
- Presence of signs of meningitis.
As part of the treatment of DIC, doctors use broad-spectrum antibacterial agents. In addition, globulins are included in the treatment regimen. To stop the state of shock, injections of saline solutions are used along with plasma transfusions with "Heparin" and "Prednisolone" intravenously, alsothe drug "Reopoliglyukin" can be used. In the event that the state of shock is overcome in a timely manner, it is possible to have time to stop the further development of DIC, or to significantly mitigate its manifestations.
Regarding "Heparin" it is worth noting that with its introduction there is a risk of bleeding. This remedy has no positive effect if it is applied too late. It needs to be entered as early as possible. It is important to strictly follow the recommended dosage. In the event that the patient is already at the third stage of the development of the syndrome, then the introduction of "Heparin" is considered a direct contraindication. Signs that indicate a ban on the use of this drug are considered symptoms in the form of a drop in pressure, hemorrhagic collapse and bleeding, which may be hidden.
In the event that the symptom is just beginning to develop, then it is advisable to introduce adrenoblockers in the form of Dibenamine, Phentolamine, Thioproperazine and Mazheptil. These drugs are administered intravenously in the required concentration. They help to normalize microcirculation in the organs, and in addition, they resist thrombosis inside the vessels. Norepinephrine and epinephrine preparations should not be used as they may worsen the situation.
Against the background of the formation of kidney or liver failure, at an early stage of the development of DIC, it is possible to use drugs in the form of Trental and Curantil. They are administered intravenously.
At the third stage of the development of this syndrome, the introduction of protease inhibitors is required. main medicin althe drug of choice in this case is "Kontrykal", the method of its administration is intravenous. If necessary, the administration of the drug can be repeated. Local impact is reduced to the treatment of bleeding wounds, erosions and other areas with the help of a six percent concentration of Androxon.
Complex treatment
Summarizing, it should be noted that the complex therapy of DIC, as a rule, comes down to the following points:
- Removing the root cause that triggered the development of the syndrome.
- Providing anti-shock treatment.
- Blood volume replenishment procedure with plasma transfusion enriched with Heparin. But such a procedure can be performed only if there are no contraindications to this.
- Timely use of adrenergic blockers, as well as drugs that help reduce the number of platelets in the blood, for example, Curantil, Trental or Ticlodipine.
- Administration of "Kontrykal" to the patient along with platelet transfusion in order to normalize hematocrit in the presence of severe bleeding.
- Assignment of plasmacytapheresis to the patient in the event that there are appropriate indications for this.
- As part of the normalization of microcirculation processes in the affected organs, nootropics are used along with angioprotectors and other syndromic drugs.
- Hemodiafiltration and hemodialysis are carried out against the background of the development of acute kidney failure.
Patients with DIC in mandatoryhospitalized, and they are under round-the-clock supervision of specialists. They are usually placed in an intensive care unit or intensive care units.
Regarding the forecast, we can say that it is very variable. To a greater extent, the prognosis depends, first of all, on what caused the development of this syndrome, and in addition, on the level of impaired hemostasis. It is equally important how quickly the first aid was provided to the patient and how adequate it was and met the needs of the patient. A lethal outcome against the background of this syndrome, unfortunately, cannot be ruled out, since it is likely to occur against the background of heavy blood loss, as a result of shock or organ failure. Doctors should pay special attention to those patients who are at risk, first of all, the elderly, pregnant women, newborns and patients with underlying pathologies.
Prophylaxis
Knowing the causes of this disease makes it possible to take preventive measures to prevent it. Of course, it is impossible to foresee absolutely everything, but following a few of the following rules will help to seriously reduce the risks of developing such a severe pathology:
- If there is a need for surgical treatment, the most sparing surgical technique should be chosen.
- Anticoagulants should be used for any pathology that can be complicated by this syndrome.
- Snake bites and all chemical intoxication should be avoided.
- No or at least minimal use of whole blood.
- Timely detection and treatment of cancer.
Conclusions
DIC is a very severe complication of clinical pathology and has a high mortality rate, depending on the cause. In this case, up to fifty percent of patients die. This is why prevention measures are considered more important than curative measures. Therefore, it is very important to follow the above tips to avoid developing this syndrome.
We looked at what DIC is in simple terms.
