DIC syndrome (disseminated intravascular coagulation syndrome, also known as thrombohemorrhagic syndrome) is a process that results in a violation of blood clotting and the formation of intravascular thrombi. The clinical picture of DIC syndrome is diverse and can manifest itself in the form of hemorrhagic rash, severe external and internal bleeding, or even be asymptomatic, being noticeable only by laboratory indicators.
DIC syndrome is a mandatory component of shocks of various genesis.
CAUSES OF DIC SYNDROME
The main cause of DIC syndrome is generalized viral and bacterial infections, sepsis. In addition, the causes may be conditions such as obstetric pathology, malignant tumors, injuries, burns, frostbite, immunocomplex vasculitis, the use of artificial heart and artificial kidney devices, a decrease in the blood level of the natural anticoagulant antithrombin III and many others.
It should also be remembered that cell aggregation can be caused by drugs such as adrenaline, oral contraceptives, aminocaproic acid. The combined use of these medications is especially dangerous.
PATHOGENESIS OF DIC SYNDROME
The key point in the occurrence of DIC syndrome is platelet aggregation with subsequent thrombosis, as well as the process of fibrinolysis. For example, tissue thromboplastin begins to circulate in the blood after various operations, myocardial infarction, during and after childbirth, as well as with serious injuries associated with tissue crushing. Activate the process of blood clotting and immune complexes that appear after infectious diseases and vasculitis. In addition, any stressful state for the body leads to the release of catecholamines and kinins, which also affect the occurrence of DIC syndrome.
PHASES OF DIC SYNDROME
There are 4 phases of DIC syndrome:
Phase I is the phase of hypercoagulation. As a result of blood loss, the number of clotting factors decreases, which increases the time of clot formation and lengthens the period of capillary bleeding.
Phase II — hypocoagulation. There is a process of activation of fibrinolysis and aggregation of blood cells.
Phase III is associated with increased activation of fibrinolysis and rapid lysis of formed blood clots
Phase IV is the period of generalized fibrinolysis. There is no complete blood clotting in the capillaries, there is internal bleeding from the parenchyma of organs, the appearance of hemorrhagic rash on the skin, the appearance of blood in the urine, bleeding from the oral cavity, etc.
DIAGNOSIS OF DIC SYNDROME
Diagnosis of DIC syndrome is carried out on the basis of anamnesis data, clinical manifestations and laboratory data. It should be remembered that DIC syndrome is a complication, not an independent disease.
As for the prognosis, it is also determined by the severity of the underlying disease, as well as the promptness of the start of treatment.
TREATMENT OF DIC SYNDROME
First of all, therapy for DIC syndrome includes the treatment of the underlying disease. Also, in order to choose the right therapy, it is necessary to know the number of platelets in the blood, their activity, as well as data on clotting factors. In an emergency plan, resuscitation measures, transfusion of freshly frozen plasma, introduction of disaggregants, subcutaneous administration of heparin, plasmapheresis, infusion therapy and the introduction of antibiotics are carried out.
PREVENTION OF DIC SYNDROME
First of all, for preventive purposes, monitoring of risk groups should be carried out, which include people with low levels of antithrombin III and erythrocytosis, as well as elderly people. They should be given special attention during the period of operations, and also be aware of the danger of latent DIC syndrome in severe chronic diseases.
