Disseminated Intravascular Coagulation (DIC)
Considerations
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Emergency: mobilize resources & delegate tasks
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Search for & correct precipitant:
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Obstetrical hemorrhage, placental abruption, amniotic fluid embolism, pregnancy-induced hypertension
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Trauma/burns
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Transfusion
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Sepsis
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Aggressive treatment: potential for massive transfusion:
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Hypothermia
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Hypocalcemia
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Factor dilution
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Thrombocytopenia
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Acidosis
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Volume overload (acute respiratory distress syndrome, acute lung injury)
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Sequelae of bleeding & thromboembolism:
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Bleeding: intracranial, thorax, abdomen, cardiac tamponade
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Thrombus: pulmonary embolism, acute renal failure, liver failure, stroke
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Goals
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Platelets: maintain above 50 000 (1 unit/10 kg; 0.1-0.2 units/kg)
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Fresh frozen plasma: 10ml/kg to maintain INR < 1.5 – 2
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Cryoprecipitate to maintain fibrinogen > 1.5 (2 units / 10 kg) (maintain > 2.0 in pregnant patients)
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pRBC’s to maintain organ perfusion
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Follow coagulation profile, fibrinogen, hemoglobin & platelets at least hourly
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Heparin not recommended (except possibly in DIC secondary to malignancies causing thrombosis)
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Antifibrinolytics not recommended