DIC-syndrome: treatment and diagnosis

DIC-syndrome is a disorder of hemostasis, which contributes to the formation of blood clots, and in addition, the development of various microcirculatory and hemorrhagic disorders. The full name of this disease sounds like disseminated intravascular coagulation, in addition, there is such a pathology designation as thrombohemorrhagic syndrome. Next, we learn how to treat this disease and how it is diagnosed.

Basic disease information

Hemorrhagic diathesis with increased coagulation of blood inside the vessels is characteristic of this syndrome. This leads to the formation of blood clots. These processes entail the development of pathological changes in organs of a dystrophic, hypoxic, and necrotic nature.

DIC-syndrome poses a threat to the life of the patient, as there is a risk of bleeding. They can be extensive and difficult to stop. Internal organs can also be involved in pathological processes, whose functioning is completely impaired. The kidneys, spleen, lungs, liver and adrenal glands are primarily at risk.

Many are interested in what are the causes of DIC.

This ailment can occur with various diseases, but absolutely always leads to thickening and disruption of blood circulation through the capillaries. Such a process is incompatible with the normal functioning of the body. DIC-syndrome can lead to lightning death of a person or to a protracted latent deadly form of violations.

The statistics of this syndrome is difficult to calculate, since with various diseases it occurs with different frequencies. Some diseases are always accompanied by this syndrome, and with other diseases it is much less common.

In DIC, the diagnostic and treatment protocol will be presented below.

This pathology should be regarded as an abnormal protective reaction of the body, which they are issued in order to be able to suppress bleeding that occurs when vascular damage occurs. So the body tries to protect itself from tissue damage. This disease is very common in medical practice of various specialties. Resuscitators, gynecologists, traumatologists, surgeons and hematologists are very familiar with this syndrome.

Consider the pathogenesis of DIC.

What happens with this?

In this case, the insolvency of the body's reactions, which are launched in order to try to prevent bleeding, is noted. This process is called hemostasis. Against this background, the function that is responsible for blood coagulation is excessively stimulated, and the fibrinolytic and anticoagulant systems balancing it, on the contrary, are depleted very quickly.

Enzymes that are produced by toxins, bacteria, immune complexes, phospholipids and so on can affect the manifestation of this syndrome. Moreover, they circulate in the bloodstream or act on the vascular endothelium.

Stages of the disease

The syndrome usually develops according to some specific patterns, passing through a series of successive stages:

• At the first stage, the process of excessive blood coagulation, as well as cell aggregation inside the vessels, starts. An excess amount of thromboplastin or substances with a similar effect is released into the blood. These processes trigger collapse. The period of the initial stage varies greatly, taking time from a minute to a couple of hours in case the syndrome develops in an acute form. Pathological processes can occur up to several months if the syndrome is chronic.
• The second stage of DIC syndrome is characterized by the launch of consumption coagulopathy processes. Against this background, the lack of platelets, fibrogen and other plasma factors that are responsible for blood coagulation processes increases in the body.
• The third stage of DIC is already considered critical. During this period, the process of secondary fibrinolysis occurs, and blood coagulation reaches its maximum until this process stops completely. Against this background, hemostasis is significantly unbalanced.
• The recovery stage is characterized by the normalization of hemostasis. On tissues and organs, residual dystrophic and necrotic changes are observed. Another end to this syndrome may be acute failure of a particular organ.

The full development of the disease, that is, its severity, and the development mechanism largely depend on the degree of disturbances in the microcirculation of blood and the level of damage to organs and systems.

One of the causes of acute DIC during pregnancy at any gestational age is intrauterine fetal death and miscarriage. Pathology of the 4th degree can lead to the death of a woman, therefore, for any signs indicating a possible termination of pregnancy, you must immediately contact the department of pathology of childbirth at the district maternity hospital.

The causes of DIC in obstetrics can be infectious. Infection of amniotic waters, prolonged bacterial infections of the internal organs of the mother, increasing the risk of bacteria and their toxins entering the bloodstream - all this can cause coagulation disorders and systemic coagulopathy, therefore it is important to treat any diseases of an infectious nature in time and follow all doctor's prescriptions.

The danger of DIC in obstetrics lies in its almost asymptomatic course. In most cases, pathology can be determined only after laboratory diagnosis, which can determine hematological disorders (changes in blood chemical parameters).

In children

DIC syndrome in newborns can be triggered by the following reasons:

• damage to the "child's place";
• intrauterine death of one of the children with multiple pregnancy;
• intrauterine infection;
• state of eclampsia and preeclampsia;
• uterine rupture;
• cystic drift.
  

Most often, the pathology is diagnosed in premature babies. The blood of the child does not contain enough procoagulants or anticoagulants, which causes increased bleeding.

DIC syndrome in a baby can develop in many diseases. The condition is typically lightning fast, which virtually eliminates the possibility of using any treatment.

Complications

Against the background of this disease, they are usually very severe and can threaten not only health but also life. More often than others, such patients, as a rule, develop the following diseases and conditions:

• The development of hemocoagulation shock. Against this background, tissues and organs in a person begin to experience oxygen deficiency, since blood vessels are disturbed in the vessels that are responsible for their nutrition. In addition, the amount of toxins in the blood itself is extremely exceeded. As a result, the patient's pressure drops sharply, shock and organ failure join.
• The development of acute respiratory failure with DIC. This condition is borderline and poses a direct threat to the patient's life. With increased hypoxia, consciousness may be lost, convulsions occur, as a result, a hypoxic coma occurs.
• The development of acute renal failure is another very common complication of this syndrome. The patient stops urinating, urine flow stops. The water-salt balance is also disturbed, and the level of nitrogen, urea and creatinine in the blood increases. But this condition is referred to as potentially reversible.
• The development of liver necrosis.
• The digestive system can be marked by the appearance of a stomach ulcer, intestinal infarction, pancreatic necrosis, and so on.
• From the side of the heart, an ischemic stroke is possible.
• The hematopoietic system reacts with acute hemorrhagic anemia.

Next, we find out what research methods are used to diagnose this pathology.

Diagnostics

The doctor builds the diagnosis of the disease during the examination of the patient, and in addition, as part of the collection of anamnesis and various laboratory tests. As part of the diagnosis, it is assumed:

• Conducting a clinical blood test.
• A study of the clinical analysis of urine.
• Blood smear test.
• Blood donation for a coagulogram. This study is the main diagnostic method for hemostasis, in the framework of which fibrogens, platelets and other important indicators are counted.
• Enzyme-linked immunosorbent assay, which examines the main markers of blood coagulation inside the vessels.
• Blood donation for paracoagulation tests allows you to refute or, conversely, confirm the diagnosis.

Thanks to all these studies, doctors are finding out the root cause that led to the onset of the syndrome. In addition, based on these tests, the stage and nature of the disease is determined.

Diagnosis of DIC should be timely.

In the event that the course of the syndrome is hidden, then hypercoagulation can be determined solely on the basis of laboratory tests. Against this background, fragmented erythrocytes will be observed in the smear, the thrombosed time will increase, and the concentration of fibrin degradation products will increase significantly. A blood test will indicate a lack of fibrinogen and platelets in it. When the syndrome is confirmed, the most vulnerable organs, such as the kidneys, heart, lungs, liver, brain, and adrenal glands, are necessarily examined.

What are the recommendations for DIC?

Treatment

The treatment of this disease is a rather complicated process; recovery of the patient may not occur in every situation. In the event that an acute form of the course of the disease was diagnosed, then a fatal outcome occurs in thirty percent of cases, which is considered a fairly high rate. Nevertheless, it is far from always possible to establish precisely the reason why the patient died. It is not always immediately clear whether this syndrome was a critical condition, or whether the patient died due to the negative impact of his underlying disease.

Doctors who observe DIC-blood syndrome, make their efforts primarily to eliminate, or at least minimize the factors that led to the development of the syndrome and stimulate its progression. First of all, it is important to be able to eliminate the purulent-septic state, which most often provokes disorders of hemostasis. Against this background, waiting for the result of a bacteriological study does not make any sense, the therapy is carried out in accordance with the clinical manifestations of the disease.

Clinical recommendations for DIC syndrome should be strictly observed.

In what cases is antibiotic therapy indicated?

Antibacterial therapy is prescribed in a number of the following cases:

• As a result of an abortion.
• Against the background of premature discharge of amniotic fluid, especially if they are not transparent and turbidity is present in them.
• Temperature increase.
• The presence of symptoms that indicate inflammation of the lungs, organs of the abdominal region or urinary tract.
• The presence of signs of meningitis.

As part of the treatment of DIC, doctors use antibacterial agents with a wide range of effects. In addition, globulins are included in the treatment regimen. In order to stop the shock state, injections of saline solutions are used along with plasma transfusions with Heparin and Prednisolone intravenously, and Reopoliglyukin can also be used. In that case, if you timely overcome the shock condition, you can manage to stop the further development of the ICE syndrome, or to significantly mitigate its manifestations.

Regarding Heparin, it is worth noting that with its introduction there is a risk of bleeding. This tool does not have a positive effect in case of its late use. It is required to enter it as soon as possible. It is important to strictly follow the recommended dosage. In that case, if the patient is already at the third stage of the development of the syndrome, then the introduction of "Heparin" is considered a direct contraindication. Signs that indicate a ban on the use of this drug are considered symptoms in the form of a drop in pressure, hemorrhagic collapse and bleeding, which may be hidden.

In the event that the symptom is just beginning to develop, then the introduction of adrenergic blockers in the form of "Dibenamine", "Phentolamine", "Thioproperazine" and "Majeptila" is considered appropriate. These drugs are administered intravenously at the required concentration. They help normalize microcirculation in organs, and in addition, resist thrombosis inside the vessels. You should not use drugs norepinephrine and epinephrine, as they can worsen the situation.

Against the background of the formation of kidney or liver failure, at the early stage of the development of DIC, it is possible to use drugs in the form of Trental and Curantil. They are administered intravenously.

At the third stage of development of this syndrome, the introduction of protease inhibitors is required. The main drug of choice in this case is Contrical, the method of its administration is intravenous. If necessary, the drug can be repeated. Local exposure is reduced to the treatment of bleeding wounds, erosions and other areas with the help of a six percent concentration of Androkson.

Conducting a comprehensive treatment

Summing up the results, it should be noted that the complex therapy of DIC syndrome, as a rule, comes down to the following points:

• Elimination of the root cause that triggered the development of the syndrome.
• Conducting anti-shock treatment.
• The procedure for replenishing blood volume with a transfusion of plasma, which is enriched in Heparin. But such a procedure can be performed only if there are no contraindications to this.
• Timely use of adrenergic blocking agents, as well as drugs that help to reduce platelet count in the blood, for example, Curantil, Trental or Ticlodipine.
• The introduction of the patient "Contricale" along with platelet transfusion in order to normalize the hematocrit in the presence of severe bleeding.
• Appointment of a patient with plasmacytapheresis if there are relevant indications for this.
• As part of the normalization of microcirculation processes in the affected organs, nootropics are used along with angioprotectors and other syndromic drugs.
• Against the background of the development of acute renal failure, hemodiafiltration and hemodialysis are performed.

Patients with the presence of DIC syndrome are hospitalized without fail, and they are under the supervision of specialists around the clock. They are usually located in the intensive care unit or in intensive care units.

Regarding the forecast, we can say that it is very variable. To a greater extent, the prognosis depends primarily on what caused the development of this syndrome, and in addition, on the level of hemostasis disturbance. It is equally important how quickly the first aid was given to the patient and how adequate it was and corresponded to the needs of the patient. Unfortunately, it is impossible to exclude a lethal outcome against the background of this syndrome, since its occurrence is likely against the background of heavy blood loss as a result of shock or organ failure. Doctors should pay special attention to those patients who are at risk, we are talking primarily about the elderly, pregnant women, newborns and patients with background pathologies.

Prophylaxis

Knowing the causes of this disease makes possible preventive measures to prevent it. Of course, it is impossible to foresee everything at all, but observing the following several rules will help seriously reduce the risks of developing such a severe pathology:

• If there is a need for surgical treatment, the most gentle surgical procedure should be chosen.
• Anticoagulants should be used for any pathology that can be complicated by this syndrome.
• It is necessary to avoid snake bites and all kinds of intoxication with chemicals.
• Failure or at least minimal use of whole blood.
• Timely detection and treatment of cancer.

conclusions

DIC-syndrome is a very serious complication of clinical pathology and has a high mortality rate, which depends on the cause. In this case, up to fifty percent of patients die. It is in connection with this that preventive measures are considered more important in comparison with therapeutic measures. , .

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