Description disseminated intravascular coagulation
Disseminated intravascular coagulation is a disease which is characterized by increased bleeding.This disease is caused by disorders of hemostasis. Hemostasis is the mechanism ensuring stop bleeding after an injury in which a breach of the vessel wall (for example, cutting or stabbing wounds, abrasions, cuts, etc.). If we hurt and breach of the vessel wall occurs, it activates a number of mechanisms that are designed to stop the bleeding as quickly as possible, so that was the least blood loss. One mechanism is known. Coagulation cascade. This cascade is made up of several substances (called the coagulation factors) which are mutually sequentially activated. Factors which are proteinaceous in nature, are formed in the liver and present in the blood at a certain concentration. At the same time, inter alia, in the blood is also dissolved protein, which is calledfibrinogen, and which is for blood clotting very substantial. The aim is to activate hemostasis last factor cascade that as the only coagulation factors can convert soluble fibrinogen to insoluble fibrin.Fibrin suddenly appears in the blood in the form of thin white filaments. In place of vessel injury produces fibrils fibrin network in which to capture blood cells (most of them are in this case the plate), which eventually clog the hole in the vessel wall just like a cork wine bottle. Blood here forms clot (thrombus). This precipitate is in the vessel wall during its gradual healing catabolized by cells of the immune system (ie. Fibrinolysis).
In disseminated intravascular coagulation occurs but to the formation of multiple clots. It is caused by a lack of control of blood coagulation and unnecessary initiation of the coagulation cascade in many places in the bloodstream. The coagulation cascade is normally controlled so that for starting it occurred only at sites of injury, and not spontaneously in places where there is no need for blood clotting. The main cause of spontaneous clot formation is a substance called tissue factor. It is not normally within the vascular system is present, but with disseminated intravascular coagulopathy yes. It is this tissue factor causes activation of the coagulation cascade, which itself then takes place and causes the formation of insoluble fibrin in the middle of the vessel. Do fibrin network as well as to stop bleeding while impaired vascular wall depict mainly platelets (thrombocytes) and there is a clot (thrombus).
As already mentioned, tissue factor is not normally found in blood vessels and therefore has to be a way to get into it. The most common way the cells of tissues that normally contain tissue factor.These cells can get into the blood vessels such as childbirth, major trauma or surgery. Another method may be a tumor-altered cells which may contain tissue factor (such as tumor-modified blood cells of leukemia).
Thrombus is when disseminated intravascular coagulopathy formed blood vessels in the middle, which is a very dangerous condition. It may be clogged during blood circulation to virtually any location of the body. That is clogged blood vessel supplying an organ usually is caused by the vessel away from the heart constrict. From the heart leads aorta, from which gradually withdraws an artery supplying the various authorities, and they are also branches into increasingly smaller blood vessels until it diverges completely to the capillary beds, which runs its own exchange of respiratory gases (oxygen and carbon dioxide), substances used for nutrition, products of metabolism of the body and so on. So if clogged catheter thrombus, which supplies the body with blood, no body at the site, which is supplied, oxygen, which is absolutely necessary for him and after a few minutes without oxygen, place cells die. This condition is called a heart attack can occur in almost any organ (heart, kidney, liver, brain …). However, since the organs supplied with more vessels, blockage of one usually results in death of the cells only a small part of the organ. Even though it can have fatal consequences. One of them is cardiac arrest, myocardial infarction (heart attack), which may be the failure to file a timely first aid to death, then another stroke (CVA) with insufficient vascular supply to the brain tissue.
The formation of clots greater extent causes are used up coagulation factors (the fixed value of blood concentration decreases), and therefore can not be further lowered coagulation cascade. This is on the one hand advantageous because it spontaneously do not form additional thrombi in blood vessels, but also very dangerous if the wound – in this time then the organism may not stop bleeding and can lead to bleeding (eg in the digestive tract during vessel injury digestive tract ).This increased bleeding called haemorrhagic disease.
Risk factors for disseminated intravascular coagulation
A risk factor is actually any massive injuries, childbirth or surgery. Especially when they can get into the blood vessel tissue cells and release the tissue factor, which then triggers the coagulation cascade that are induced thrombus formation. Another danger then form tumors (tumor altered cells may unleash your tissue factor in the arteries), pancreatitis, sepsis, systemic inflammation, and various infections (viral hemorrhagic fevers). At the same time they constitute a risk but also a group of patients with a predisposition to thrombosis – immobilized (immobile), dehydrated.Furthermore, people with thrombophilia loads (eg. Leiden Factor V). They include but less traditional hazards such as bite of some poisonous snakes such as the rattlesnake.
Prevention of disseminated intravascular coagulation
To protect yourself from this disease is practically impossible because they were so hard we prevent that we must not get in a serious injury to body cells of blood vessels. But we can implement some of the measures as a precaution before the occurrence of clots. When traveling it is advisable to make regular stops or exercises where you limber limbs (this applies mainly for long trips should be plane). It is also necessary to receive sufficient amounts of fluids and if you suffer from varicose veins, wear compression stockings.
Symptoms of disseminated intravascular coagulation
The main symptom of disseminated intravascular coagulation is increased bleeding. On the patient, then we can observe the different kinds of bruises – from small to deep subcutaneous and also petechiae (tiny purpura, bleeding needle visible on the skin as small red puntíčky). Bleeding but also takes place inside the body and can be massive, so are other signs of paleness, tiredness, lapses into unconsciousness. When embolism thrombus is then a symptom of failure (complete or partial) of the body – for example, for heart attacks astringent to burning chest pain that radiates to the arms, burning in the throat, toothache to cardiac arrest.
The treatment of disseminated intravascular coagulation
Prior to initiation of the treatment is necessary to investigate pacineta order to determine whether the preliminary diagnosis is correct. This is mainly on laboratory tests of coagulation and hemostasis. In this test, the patient removes the blood which then examines the time for which will take place coagulation cascade and being struck. Investigated is the prothrombin time (PT) and activated partial thromboplastin time (APTT) and will Quick test. For all of these test measures how long it will create insoluble fibrin in the blood under certain predetermined conditions that are in all other tests and speak about other possible reasons for problems with blood clotting.
The basis of treatment is to restore the regulation of coagulation. The following, therefore, the coagulation factors. However, to assume a more thrombi administered heparin. Heparin is a substance inhibiting blood clotting, is also known as a remedy for its dilution and applied to the needle into the dermis. Another substance that is administered can be antithrombin III and frozen plasma.
Because may occur during this disease and blood loss during their detection is completed transfusion.
Treatment is divided into three phases, the first treat life-threatening circumstances – when massive bleeding patient gets immediate transfusion during heart pledges, organ failure and the like first aid. In a second step, disseminated intravascular coagulation, which comprises administering heparin and antithrombin III. Finally, it is then treated with primary disease that disseminated intravascular coagulation caused.
How I can help the treatment of disseminated intravascular coagulation
Because it is a serious disease, it is very important to seek timely medical attention. As a complement to treatment is good to take vitamin C.
Complications
One of the most serious complications of bleeding, which the patient does not know – located for example in the injured digestive Tubic and is not visible. Since there is no blood coagulation, and its stop, the patient may bleed to death.
Other complications include myocardial tissue that has been thrombus practically disconnected from the supply of oxygen. In certain cases, the failure to provide timely medical assistance may occur even death.
Thrombi threaten all tissues, but the most serious consequences are myocardial infarction (cardiac arrest), infartku brain tissue, which is called cerebrovascular accident (there may be varying degrees of paralysis, mental disorders, etc.) Infartku lungs, kidneys, liver.
Other names: Disseminated intravascular coagulation, DIC, disseminated intravascular coagulopathy, Defibrination syndrome, bleeding, disseminated intravascular coagulation of blood