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Damaged endothelial cell walls trigger activation of the intrinsic clotting cascade
誘發而引起廣泛凝血反應
-> Intravascular thrombin generation, small vessel thrombosis
進而消耗了很多凝血因子和血小板
同時也活化了溶血系統 (fibrinolytic system)
- > breakdown of fibrin clots and subsequent bleeding
凝血功能全面失衡
血栓、出血都可能發生 → 多重器官衰竭
Tintinalli 如是說 :
Clinical features of DIC vary with the underlying precipitating illness.
Hypercoagulation may predominate in certain conditions
such as sepsis, where signs of ischemic end-organ failure are common,
and physical findings in these patients may include cutaneous gangrene or thrombotic purpura.
而且上面的表格也寫 septic patients are more likely to have thrombosis than bleeding ???
但查其他資訊 (Uptodate) :
Acute DIC is typically seen in settings such as sepsis, trauma, or acute promyelocytic leukemia
The consumption coagulopathy, combined with the high concentration of FDPs,
leads to the severe bleeding diathesis seen in decompensated DIC
Chronic DIC is typically seen in patients with advanced malignancy,
especially pancreatic, gastric, ovarian, and brain tumors.
Thrombosis generally predominates over bleeding
感染/外傷 Acute DIC = 出血
癌症 Chronic DIC = 凝血
Fibrinogen 會被切割成 Fibrin 而凝血
所以 DIC 時 Fibrinogen 會下降 (被消耗)
FDP (fibrin degradation products) 是 Fibrinogen / Fibrin 分解後的產物
DIC 時 FDP 會上升
Generally speaking, blood products should only be administered when there is evidence of bleeding.
FFP : The initial recommended dose is 15 mL/kg
although there is some evidence of 30 mL/kg (若不擔心 volume overload)
No proven benefit in DIC with other coagulation factor products
(PCC, prothrombin or coagulation factor VIIa)
https://thetinynotes.com/topic/204/%E7%80%B0%E6%BC%AB%E6%80%A7%E8%A1%80%E7%AE%A1%E5%85%A7%E5%87%9D%E8%A1%80-dic
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