Disseminated Intravascular Coagulation
Disseminated intravascular coagulation
Također poznato kao: DIC
Ukratko
Disseminated intravascular coagulation (DIC) is a life-threatening, secondary clotting disorder in dogs and cats. Triggered by severe underlying diseases like sepsis or trauma, it causes widespread micro-clots and severe bleeding, requiring immediate emergency veterinary intervention.
TL;DR. DIC je kritični sindrom zgrušavanja u teškoj bolesti: mikrotrombi u malim žilama i istodobno nekontrolirano krvarenje zbog potrošnje čimbenika zgrušavanja.
Pacijenti s DIC-om trebaju intenzivnu hospitalizaciju i stalnu podršku.
Što je to?
DIC nije primarna bolest nego sekundarni sindrom. Masovno aktivira zgrušavanje u mikrocirkulaciji (mikrotrombi), troši trombocite i antikoagulanse te zatim uzrokuje krvarenje i zatajenje organa. Fibrinoliza se paralelno ubrzava.
Uzroci i čimbenici rizika
Uvijek sekundarno. Često sepsa i SIRS; također trauma, pankreatitis, napredni tumori (npr. hemangiosarkom), toplinski udar, teške infekcije, ugriz zmije. Greyhoundi mogu imati atipične profile zgrušavanja.
"DIC invariably occurs as a complication of an underlying disorder; sepsis and the systemic inflammatory response syndrome (SIRS) are the most common causes in humans and dogs."
Znakovi na koje treba paziti
- Anemija (česta): blijede desni, slabost.
- Petehije, ekhimoze (povremene)
- Epistaksa, krvarenje desni, GI ili mokraćno (povremeno)
- Prolongirano krvarenje s mjesta punkcije (povremeno)
- Intrakavitarno krvarenje, hematomi (povremeno)
- Aritmije, znakovi organa (povremeno)
Petehije na desnima signaliziraju tešku potrošnju resursa zgrušavanja.
Kako veterinari dijagnosticiraju
Klinika i lab: trombociti i razmaz (shistociti, trombocitopenija), PT/aPTT, FDP/D-dimer, antitrombin, eventualno TEG; biokemija i urin za okidač i organe.
"These include a regenerative hemolytic anemia (although occasionally, because the animal has a chronic disorder such as cancer, the anemia is non regenerative), hemoglobinemia (caused by intravascular hemolysis), RBC fragments or schistocytes, thrombocytopenia, neutrophilia with a left shift, and rarely neutropenia."
Razmaz pomaže prepoznati trombocitopeniju i fragmentirane eritrocite.
Mogućnosti liječenja
Hitna intenzivna skrb i liječenje uzroka.
- Tekućine i ekspanderi: i.v. tekućine; eventualno Dextran 70 za mikrocirkulaciju.
- Antikoagulacija: nefrakcionirani Heparin oprezno i uz nadzor.
- Antiagregacija: niska doza Aspirin u odabranim slučajevima.
- Antidot heparina: Protamine Sulfate pri krvarenju od heparina.
"Once a diagnosis of DIC has been established, or even if the degree of suspicion is high that DIC is present, treatment should be instituted without delay. Unfortunately, no controlled clinical trials have been performed in veterinary medicine evaluating the effects of different treatments in dogs with DIC, so this discussion reflects my recommendations for the treatment of dogs with this condition."
Prognoza
Ozbiljna. Smrtnost pasa ~54 %; u mačaka vrlo visoka. Preživljenje ovisi o kontroli okidača.
Prevencija
Nema izravne prevencije. Ključ: rano agresivno liječenje bolesti visokog rizika za DIC.
Kada zvati veterinara
Odmah pri: spontanom krvarenju; petehijama/ekhimozama; kolapsu; blijedim desnima; dispneji; krvi u mokraći, stolici ili povraćanju.
Za određene pasmine
Greyhound: atipično zgrušavanje; u teškoj bolesti ili operaciji razmotrite proaktivne panele zgrušavanja.
Izvori
- Internal Medicine, 5th Edition, pages 1292, 1293, 1294, 1295.
- Small Animal Critical Care Medicine, 2nd Edition, page 625.
My highlights & notes
Znakovi i simptomi
Pasmine s višim rizikom
Kako se dijagnosticira
- Activated Partial Thromboplastin Time (aPTT)
- Antithrombin (AT) concentration
- Blood smear examination
- D-dimer test
- Fibrin degradation products (FDPs) test
- One-stage prothrombin time (OSPT / PT)
- Platelet count
- Serum Biochemistry
- Thromboelastography (TEG)
- Urinalysis
Pristupi liječenju
Liječenje mora propisati licencirani veterinar. Specifične doze namjerno nisu prikazane.
Česta pitanja
What is Disseminated Intravascular Coagulation?
Disseminated intravascular coagulation (DIC) is a life-threatening, secondary clotting disorder in dogs and cats. Triggered by severe underlying diseases like sepsis or trauma, it causes widespread micro-clots and severe bleeding, requiring immediate emergency veterinary intervention.
What are the symptoms of Disseminated Intravascular Coagulation?
Anaemia (pale gums)、Cylindruria、Bruise-like patches under the skin、Nosebleed、Gastrointestinal hemorrhage、Red or cola-colored urine、Intracavitary hemorrhage、Mucosal bleeding
How is Disseminated Intravascular Coagulation diagnosed?
Activated Partial Thromboplastin Time (aPTT)、Antithrombin (AT) concentration、Blood smear examination、D-dimer test、Fibrin degradation products (FDPs) test、One-stage prothrombin time (OSPT / PT)
How is Disseminated Intravascular Coagulation treated?
Liječenje mora propisati licencirani veterinar. Specifične doze namjerno nisu prikazane.
Izvori
- Internal Medicine 5th · p. 1292
- Internal Medicine 5th · p. 1295
- Internal Medicine 5th · p. 1294
- Internal Medicine 5th · p. 1293
- Small Animal Critical Care Medicine, 2nd Edition (VetBooks.ir) · p. 625
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