tailieunhanh - Chapter 110. Coagulation Disorders (Part 9)

Differential Diagnosis The differential diagnosis between DIC and severe liver disease is challenging and requires serial measurements of the laboratory parameters of DIC. Patients with severe liver disease are at risk for bleeding and manifest laboratory features including thrombocytopenia (due to platelet sequestration, portal hypertension, or hypersplenism), decreased synthesis of coagulation factors and natural anticoagulants, and elevated levels of FDP due to reduced hepatic clearance. However, in contrast to DIC, these laboratory parameters in liver disease do not change rapidly. Other important differential findings include the presence of portal hypertension or other clinical or laboratory evidence of underlying liver. | Chapter 110. Coagulation Disorders Part 9 Differential Diagnosis The differential diagnosis between DIC and severe liver disease is challenging and requires serial measurements of the laboratory parameters of DIC. Patients with severe liver disease are at risk for bleeding and manifest laboratory features including thrombocytopenia due to platelet sequestration portal hypertension or hypersplenism decreased synthesis of coagulation factors and natural anticoagulants and elevated levels of FDP due to reduced hepatic clearance. However in contrast to DIC these laboratory parameters in liver disease do not change rapidly. Other important differential findings include the presence of portal hypertension or other clinical or laboratory evidence of underlying liver disease. Microangiopathic disorders such as thrombotic thrombocytopenic purpura present an acute clinical onset of illness accompanied by thrombocytopenia red cell fragmentation and multiorgan failure. There is however no consumption of clotting factors or hyperfibrinolysis. Disseminated Intravascular Coagulation Treatment The morbidity and mortality associated with DIC are primarily related to the underlying disease rather than the complications of the DIC. The control or elimination of the underlying cause should therefore be the primary concern. Patients with severe DIC require control of hemodynamic parameters respiratory support and sometimes invasive surgical procedures. Attempts to treat DIC without accompanying treatment of the causative disease are likely to fail. Management of Hemorrhagic Symptoms The control of bleeding in DIC patients with marked thrombocytopenia platelet counts 10 000-20 000 mm3 and low levels of coagulation factors will require replacement therapy. The PT x normal provides a good indicator of the severity of the clotting factor consumption. Replacement with FFP is indicated 1 unit of FFP increases most coagulation factors by 3 in an adult without DIC . Low levels of .