DIC- DISSEMINATED INTRAVASCULAR COAGULATION TTP- THROMBOTIC THROMBOCYTOPENIC PURPURA Dr Tzoran Inna Thrombosis and Hemostasis Unit Rambam Medical Center
DICDISSEMINATED INTRAVASCULAR COAGULATION
Widespread coagulation activation Unregulated consumption of thrombocytes ad coagulation factors Bleeding or thrombosis
Bleeding is most frequent Bleeding of skin and gastrointestinal tract Thrombosis frequently associated with malignancy
DIC - REASONS Sepsis Gynecological catastrophe – abruptio placenta, amniotic fluid emboli Malignancy-APL Multiple trauma Burns Hypertermia Snake bite
CHRONIC DIC Slow, sub-clinical course Malignancy- prostata, pancrease Intrauterine death Aortic aneurism Large hemangioma
DIC- LABORATORY TESTS Prolonged PT, PTT Low fibrinogen Low thrombocytes High D-Dimers
PLT PT PTT RBC Fragments DIC Low Prolonged + Liver Cirrhosis Low Prolonged ± Massive Bleeding Low Prolonged ± TTP Low Normal +++
DIC - TREATMENT Treatment of the precipitating factor Bleeding treated with FFP, thrombocytes, cryoprecipitate Thrombosis treated with heparin, LMWH Newest treatments Activated Protein C TFPI Anti-thrombin
TTP- THROMBOTIC THROMBOCYTOPENIC PURPURA von Willebrand factor (v. WF) cleaving protease ADAMTS 13 deficiency Accumulation of large multimers of VWF
TTP Clinical Syndrome Thrombocytopenia Hemolytic anemia High LDH Neurological symptoms RBC fragments
Inherited lack of ADAMTS 13 Acquired antibodies to ADAMTS 13 - Gram neg bacteremia - Pregnancy - Drugs - HIV - Malignancy - Organ or BM transplantation
TTP- TREATMENT Plasmapheresis with plasma or albumin Rithuximab Avoid thrombocytes infusion
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