Podcast
Questions and Answers
What is the primary purpose of heparin as an anticoagulant drug?
What is the primary purpose of heparin as an anticoagulant drug?
What medication is NOT indicated in the treatment of DIC?
What medication is NOT indicated in the treatment of DIC?
In the case of Jude, which laboratory findings indicated a severe inflammatory response?
In the case of Jude, which laboratory findings indicated a severe inflammatory response?
What should be assessed to determine the treatment approach for DIC?
What should be assessed to determine the treatment approach for DIC?
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Which antibiotics were prescribed for Jude's treatment?
Which antibiotics were prescribed for Jude's treatment?
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What was the primary presenting complaint of the patient?
What was the primary presenting complaint of the patient?
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What is the most notable laboratory finding in this case?
What is the most notable laboratory finding in this case?
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Which of the following is NOT a component of the workup plan for this patient?
Which of the following is NOT a component of the workup plan for this patient?
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What is a proposed medical treatment to address underlying causes in cases like this?
What is a proposed medical treatment to address underlying causes in cases like this?
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Which supportive care measure is recommended?
Which supportive care measure is recommended?
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What is a critical component to manage if the patient is experiencing hemorrhage?
What is a critical component to manage if the patient is experiencing hemorrhage?
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In which situation would anticoagulation be considered?
In which situation would anticoagulation be considered?
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What percentage of neutrophils was recorded in the patient’s lab data?
What percentage of neutrophils was recorded in the patient’s lab data?
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What is the initial trigger for inappropriate coagulation in the clinical syndrome described?
What is the initial trigger for inappropriate coagulation in the clinical syndrome described?
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Which of the following factors contributes to platelet adhesion?
Which of the following factors contributes to platelet adhesion?
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What is the primary outcome when thrombin production outstrips the available coagulation factors?
What is the primary outcome when thrombin production outstrips the available coagulation factors?
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What role do endogenous anticoagulant molecules play in coagulation?
What role do endogenous anticoagulant molecules play in coagulation?
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Which cells are primarily responsible for triggering thrombin production?
Which cells are primarily responsible for triggering thrombin production?
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What happens to the endothelial glycocalyx during coagulation?
What happens to the endothelial glycocalyx during coagulation?
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Which of the following is a component of the endothelial glycocalyx?
Which of the following is a component of the endothelial glycocalyx?
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What is a consequence of platelet aggregation into microclots?
What is a consequence of platelet aggregation into microclots?
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What characterizes DIC as an acquired syndrome?
What characterizes DIC as an acquired syndrome?
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Which of the following conditions is NOT associated with DIC?
Which of the following conditions is NOT associated with DIC?
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During which phase does non-overt DIC predominantly exhibit a hypercoagulable state?
During which phase does non-overt DIC predominantly exhibit a hypercoagulable state?
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What is a hallmark finding in overt DIC?
What is a hallmark finding in overt DIC?
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Which laboratory indicator is used for diagnosing DIC?
Which laboratory indicator is used for diagnosing DIC?
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Which of the following coagulation times indicates non-overt DIC?
Which of the following coagulation times indicates non-overt DIC?
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What does increased D-dimer levels indicate in the context of DIC?
What does increased D-dimer levels indicate in the context of DIC?
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Which physiological response is a sign of systemic inflammation related to DIC?
Which physiological response is a sign of systemic inflammation related to DIC?
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In what state is fibrinogen concentration during non-overt DIC?
In what state is fibrinogen concentration during non-overt DIC?
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Which of the following might worsen hemorrhaging in overt DIC?
Which of the following might worsen hemorrhaging in overt DIC?
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Which protein is crucial in deactivating coagulation factors?
Which protein is crucial in deactivating coagulation factors?
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What treatment approach is suggested for managing DIC?
What treatment approach is suggested for managing DIC?
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Which clinical sign is characteristic of thrombocytopenia in overt DIC?
Which clinical sign is characteristic of thrombocytopenia in overt DIC?
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What does activating tissue factor pathway inhibitor (TFPI) do in the context of DIC?
What does activating tissue factor pathway inhibitor (TFPI) do in the context of DIC?
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Study Notes
Disseminated Intravascular Coagulopathy (DIC)
- A clinical syndrome where inflammation triggered by disease triggers inappropriate activation of coagulation
- Activation of coagulation leads to platelet activation and thrombin formation, causing aggregation into microclots
- Platelets travel to organs, obstructing arterial flow, potentially damaging organs
- Continuous thrombin production depletes coagulation factors, ultimately preventing clot formation leading to bleeding
- Platelet adhesion is supported through connections with von Willebrand Factor, Collagen and Fibrinogen
- Endogenous anticoagulant molecules such as antithrombin, Protein C/S, and Tissue Factor Pathway Inhibitor (TFPI) play a critical role in regulating coagulation
How Coagulation Occurs Without Tissue Damage
- Monocytes or other cells initiate thrombin production
- Tissue factor expression on cells
- Exposure of adhesion molecules on endothelial surfaces by degradation of endothelial glycocalyx
- Cell adhesion molecules
Endogenous Anticoagulant Molecules
- Antithrombin
- Protein C/S
- Tissue Factor Pathway Inhibitor (TFPI)
Fibrinolysis
- Triggered by clot formation
- Allows clot breakdown and restoration of blood flow through plasmin/plasminogen
DIC Types
Non-Ovet DIC
- Activation of coagulation is buffered by anticoagulant mechanisms (i.e. thrombin-antithrombin, Tissue factor and Tissue Factor Pathway Inhibitor).
- Predominantly hypercoagulable at this time
- Increased fibrinogen due to inflammation
- Risk of thrombosis/thromboembolism
Overt DIC
- The body's compensatory mechanisms are exceeded, leading to:
- Thrombocytopenia
- Decreased fibrinogen levels (and other clotting factors)
- Hemorrhagic phenotype (petechiae, ecchymoses, epistaxis, and cavitary bleeding)
- Activation of fibrinolysis worsens hemorrhage
- Organ failure due to previously formed clots
DIC Diagnosis
Platelets
- Consumptive thrombocytopenia (platelet count between 40-100 x 10³/μL (canine))
- Platelet clumping observed on blood smear
Coagulation Profile
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT): Prolonged
- Fibrinogen concentration: Decreased with consumption
Fibrinolysis Markers
- D-dimer: Increased in circulation
- FDP: No longer measured
Decreased Anticoagulant Proteins
- Protein C/Protein S
- Antithrombin
- Tissue Factor Pathway Inhibitor (TFPI)
DIC Diagnosis: Systemic Inflammation
- Systemic Inflammatory Response Syndrome (SIRS) criteria (rectal temperature, heart rate, respiratory rate, and blood pressure)
- Evidence of predisposing disease (e.g., snake bite, organ volvulus, neoplasia)
Plan/Overall Treatment
- Identify the inciting cause to initiate treatment
- Eliminate the inciting cause
- Treat treatable conditions
- Replace fibrinogen/clotting factors if bleeding
- Consider anticoagulation if clotting
DIC Treatment
- Resolve underlying cause by providing medical or surgical treatment:
- Antibiotics (if infection present)
- Supportive care (e.g., fluids, RBC transfusions, oxygen support)
- Preventing additional inflammation
- Drain/flush/remove inflammatory areas (if needed, e.g.abscess, neoplasia, septicemia)
- Stop hemorrhage if present with fresh frozen plasma or whole blood
- Decrease overt coagulation if present by evaluating high-risk patients (e.g., IMHA, cardiac disease, severe sepsis, severe sustained systemic inflammation, colitis, or ischemia/shock) and considering the risks/benefits
Prophylactic Anticoagulation
- Unfractionated or low-molecular weight heparins to bind and neutralize factors II and X
- Antiplatelet drugs (No evidence in DIC)
Additional Laboratory Findings for DIC Diagnosis
- Platelet counts
- Coagulation times
- Indicators of fibrinolysis
- Evidence of RBC fragmentation
- Indicators of clot formation
Other Information
- Liver aspirate: Findings of degenerate neutrophils/bacterial rods/severe inflammation might indicate septic condition
- Antifibrinolytics: ɛ-aminocaproic acid or tranexamic acid may be indicated in some rare cases where hyperfibrinolysis is a significant factor.
- Treatment Decisions: Treatment decisions need to be individualized based on the patient's clinical status, risk factors, and coagulation/fibrinolytic test results and monitored closely (e.g., coagulation status, oxygen delivery, and organ function).
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Description
This quiz covers the clinical syndrome of Disseminated Intravascular Coagulopathy (DIC), focusing on its pathophysiology, including the inappropriate activation of coagulation, platelet aggregation, and organ damage. Additionally, it explores the mechanisms behind coagulation without tissue damage and the roles of various anticoagulants. Test your knowledge on this critical medical condition.
