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Questions and Answers
What is the most likely underlying condition causing disseminated intravascular coagulation (DIC) in this patient?
Obstetric complications, such as postpartum hemorrhage or placental abruption.
What initiates the uncontrolled activation of the coagulation cascade in DIC?
Release of tissue factor (thromboplastin).
What are the consequences of the uncontrolled activation of the coagulation cascade in DIC?
Formation of fibrin- and platelet-rich thrombi, consumption of platelets, coagulation factors, and fibrinogen.
What laboratory findings would be expected in a patient with DIC?
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What is the paradoxical consequence of DIC, despite the consumption of coagulation factors?
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What is the likely cause of the microangiopathic hemolytic anemia seen in this patient?
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What is the treatment approach for a patient with DIC?
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What specific blood products may be required for resuscitation in a patient with DIC?
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Study Notes
Disseminated Intravascular Coagulation (DIC)
- Obstetric complications, such as postpartum hemorrhage and placental abruption, are a major cause of DIC due to large volume of bleeding.
- Significant bleeding can cause release of tissue factor (thromboplastin), leading to uncontrolled activation of the coagulation cascade and consumptive coagulopathy.
Pathophysiology of DIC
- Uncontrolled activation of coagulation cascade leads to formation of fibrin- and platelet-rich thrombi.
- Thrombi consume platelets (thrombocytopenia), coagulation factors (evidenced by prolonged PT/INR and PTT), and fibrinogen.
- Fibrinolysis is triggered to degrade clots, elevating D-dimer (a fibrin degradation product) and depleting antithrombin and proteins C and S.
Clinical Presentation of DIC
- Patients with DIC may develop symptoms of thrombosis, such as dyspnea, chest pain, and tachypnea due to pulmonary embolus.
- Thrombi in vasculature can shear red blood cells, leading to microangiopathic hemolytic anemia (evidenced by elevated total bilirubin levels).
Management of DIC
- Patients with DIC require emergency supportive care, including treatment of underlying etiology (eg, uterine atony causing postpartum hemorrhage).
- Resuscitation with blood products (eg, packed red blood cells, fresh frozen plasma) is necessary to manage DIC.
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Description
Learn about disseminated intravascular coagulation (DIC) as a complication of obstetric conditions like postpartum hemorrhage and placental abruption. Understand how excessive bleeding can trigger the coagulation cascade, leading to a consumptive coagulopathy involving fibrin and platelets.
