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Chapter 110. Coagulation Disorders (Part 7)

Disseminated Intravascular Coagulation DIC is a clinicopathologic syndrome characterized by widespread intravascular fibrin formation in response to excessive blood protease activity that overcomes the natural anticoagulant mechanisms. DIC is associated with several underlying pathologies (Table 110-2). The most common causes are bacterial sepsis, malignant disorders such as solid tumors or acute promyelocytic leukemia (APL), and obstetric causes. DIC is diagnosed in almost half of pregnant women with abruptio placentae or with amniotic fluid embolism. Trauma, particularly to the brain, can also result in DIC. The exposure of blood to phospholipids from damaged tissue, hemolysis, and endothelial damage are all. | Chapter 110. Coagulation Disorders Part 7 Disseminated Intravascular Coagulation DIC is a clinicopathologic syndrome characterized by widespread intravascular fibrin formation in response to excessive blood protease activity that overcomes the natural anticoagulant mechanisms. DIC is associated with several underlying pathologies Table 110-2 . The most common causes are bacterial sepsis malignant disorders such as solid tumors or acute promyelocytic leukemia APL and obstetric causes. DIC is diagnosed in almost half of pregnant women with abruptio placentae or with amniotic fluid embolism. Trauma particularly to the brain can also result in DIC. The exposure of blood to phospholipids from damaged tissue hemolysis and endothelial damage are all contributing factors to the development of DIC in this setting. Purpura fulminans is a severe form of DIC resulting from thrombosis of extensive areas of the skin it affects predominantly young children following viral or bacterial infection particularly those with inherited or acquired hypercoagulability due to deficiencies of the components of the protein C pathway. Neonates homozygous for protein C deficiency also present high risk for purpura fulminans with or without thrombosis of large vessels. Table 110-2 Common Clinical Causes of Disseminated Intravascular Coagulation Sepsis Bacterial Staphylococci streptococci pneumococci meningococci gram-negative bacilli Viral Mycotic Parasitic Rickettsial Trauma and tissue injury Brain injury gunshot Extensive burns Fat embolism Rhabdomyolysis Vascular disorders Giant hemangiomas Kasabach-Merrit syndrome Large vessel aneurysms e.g. aorta Obstetric .