what is DIC
Disseminated intravascular coagulation
Rare serious condition that disrupts blood flow
Blood clotting that can run into uncontrollable bleeding
Can affect people who have cancer or sepsis
Sepsis - diffuse activation r infammortory disease
Cancer - presence of cancer procgulation
Trauma - damage o endothelial cells increase in circulatory pro inflammatory cytokines
Affect recovering from complication of pregnancy and delivery or who have ben njured
Obstretric causes
Haemmorhage particularly abruption
Pre eclampsia or HELLP
Amniotic fluid embolism - amniotic fluid gets into maternal blood flow
Massive necktie particularly intrauterine
Retention of a fetus who has passsed away more than 1 month
Sepsis
PPH
Acute fatty liver of birth
What is it
Acquired coagulation disorder
Pathological activation of coagulation resulting in widespread micro vascular rhomboid ans simultaneous bleeding
Placenta is in a heightened state of coagulation activation
Associated lab value
Decrease platelets
Decreases fibrinogen
Increase d Dimer
Pathogenesis
Increase release of expression of tissue factor
Mass activation of clotting cascade
Thrombin generation more Han antithrombotic pathways
Consumption of platelets, fibrinogen prothrombin - tendency to blea, haemorrhage component to tisssue injury - acute re menatl failure, pulmonary disease, bleeding mucuous membrane
Widespread deposition o tissue ischaemia due to fibrillation closets in small vesssels
What are the consequences
Confusion
Coma
Cva
Adult respiratory distress syndrome
Hypotension
Renal failure
Bleeding from venepuncture sites
Retroperitoneal bleeds
Skin bleeding/ rash
Death
Non obstretric cause
Sepsis
Trauma
Organ damage
ABO incompatibiky
Vascular incompatibility
Vascular aneurysm
Acute liver failure
Toxic and immunological causes
Narcotic drugs
Leukomia
Transparent rejection
How to diagnose
Clinical feature
Can be asymptomatic
Serial blood tests
International society on thrombosis hemostasis is DIC score
Treatment depends on the cause
Infective
Haemorrhagic
Liver
Liver
Pregnancy specific
Dleievery of fetus and empty of the Su terms
Takes 24-48hr to resolve
Supportive measures
Replace blood products
Fresh frozen plan
Red packed cells
Platelets
Cryoprecipitate or recombinant fibrinogen
Recombinant factor VIIa (expensive)
Caution re acidosis and hypothermia as interfere with coagulation factor complex assembly reduce enzyme activity and impair platelet activation
Should they hae anticoagulant
No evidence to suppor benefit
Needs to careful balance
Where will you look after patient
ItU
Who will be involved in care
MDT - idwife obsterecian , anaesthetists, icu nurse, physician haematologist
Should they get pregnant again
Yes they can
