DIC syndrome: causes, symptoms and treatment
DIC syndrome is a disorder of the hemostasis process, which contributes to the formation of blood clots, as well as the development of various hemorrhagic and microcirculatory disorders. The full name of the disease is disseminated intravascular coagulation; you can also find such a syndrome designation as thrombohemorrhagic syndrome.
DIC syndrome is characterized by hemorrhagic diathesis with increased blood coagulation inside the vessels, which leads to the formation of blood clots that stop them. This, in turn, entails the development of pathological changes in the organs of a dystrophic-necrotic and hypoxic nature.
DIC syndrome poses a threat to the patient's life, since there is a risk of bleeding. They are extensive and difficult to stop. Also, internal organs may be involved in the pathological process, the functioning of which will be completely disrupted. The kidneys, liver, spleen, lungs and adrenal glands are primarily at risk.
The syndrome can occur with a variety of pathologies, but it always leads to thickening of the blood, disruption of its circulation through the capillaries, and this process is not compatible with the normal life of the human body.
DIC syndrome can lead to both lightning-fast death of the patient and to protracted latent fatal forms of disorders.
The statistics of disseminated intravascular coagulation cannot be counted, since the syndrome occurs with different frequencies in different diseases. Some pathologies are always accompanied by disseminated intravascular coagulation syndrome, while in other diseases it is less common. This syndrome can be regarded as an abnormal protective reaction of the body, which it produces in order to suppress the bleeding that occurs when the vessels are damaged. Thus, the body seeks to protect itself from the affected tissues. Thrombohemorrhagic syndrome is often found in the practice of doctors of various specialties. Gynecologists, surgeons, resuscitators, traumatologists, hematologists, etc. are familiar with him.
Content:
- Causes of disseminated intravascular coagulation
- What happens with disseminated intravascular coagulation?
- Symptoms of DIC
- Complications of disseminated intravascular coagulation
- Diagnosis of disseminated intravascular coagulation
- Treatment of disseminated intravascular coagulation
Causes of disseminated intravascular coagulation
The causes of disseminated intravascular coagulation are various diseases that are accompanied by damage to tissues, blood vessels and blood cells. At the same time, hemostasis fails in the body with an increase in blood clotting.
The following pathological processes can lead to the development of thrombohemorrhagic syndrome:
- Any shock conditions of the body. Shock can occur due to an injury, against the background of a burn. Development of hemorrhagic, anaphylactic, septic, cardiogenic shock is possible. The longer the shock, the stronger it is, the brighter the DIC will be. (read also: Anaphylactic shock - causes, symptoms and treatment)
- Septic conditions, which are a complication of a viral or bacterial infection. Septic shock always provokes the development of this syndrome.
- Generalized infections. In this case, the syndrome most often occurs in newborns.
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Obstetric pathologies - severe gestosis, premature placental abruption or its presentation, fetal death inside the womb, manual separation of the placenta, uterine bleeding, cesarean section, embolism with anatomical fluid.
- Surgical interventions accompanied by an increased risk of patient injury. Most often, these are operations that are carried out to remove malignant neoplasms, interventions performed on organs that mainly consist of parenchyma, and vascular surgery. If at the same time the patient requires a massive blood transfusion, or he develops collapse or bleeding, then the risk of developing thrombohemorrhagic syndrome increases.
- Any terminal state of the human body leads to the development of DIC syndrome of varying severity.
- With a 100% probability, disseminated intravascular coagulation syndrome will develop in humans against the background of intravascular hemolysis. The destruction of blood cells most often occurs when a person is transfused with blood that is not of his group (incompatible transfusion).
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Risk factors for the development of disseminated intravascular coagulation syndrome are such surgical procedures as organ transplantation, implantation of a prosthesis of a heart valve or vessels, and the need to artificially start blood circulation.
- Taking certain medications increases your risk of developing the syndrome. These are diuretics, oral contraceptives, drugs from the group of fibrinolysis inhibitors and Ristomycin (an antibacterial drug).
- Giant angiomas with their multiple appearance.
- Bites of poisonous snakes and other acute poisoning of the human body are capable of provoking the development of DIC syndrome.
- In some cases, allergic reactions become the cause of the development of a dangerous condition.
- Immune diseases such as rheumatoid arthritis, glomerulonephritis, systemic lupus erythematosus, etc.
- Vascular pathologies, including congenital heart defects, myocardial infarction, heart failure, etc.
Nevertheless, the main reason for the development of DIC is sepsis (virological and bacteriological) and shock of any etiology. These pathologies account for up to 40% of all registered DIC syndromes. When it comes to newborn babies, this figure rises to 70%. But instead of the term DIC syndrome, doctors use the designation "malignant purpura of the newborn."
What happens with disseminated intravascular coagulation?
With disseminated intravascular coagulation (DIC), there is a failure of a complex of body reactions that are triggered in order to prevent bleeding. This process is called hemostasis. In this case, the function responsible for blood clotting is overstimulated, and the anticoagulant (anticoagulant) and fibrinolytic systems that balance it, on the contrary, are rapidly depleted.
Enzymes produced by bacteria that have entered the body, toxins, immune complexes, amniotic fluid, phospholipids, low cardiac effusion into the bloodstream, acidosis and other factors pathogenic for the body are capable of influencing the manifestation of DIC syndrome. In this case, they will circulate either in the bloodstream, or affect the vascular endothelium by means of mediators.
DIC always develops according to certain patterns and goes through several successive stages:
- At the first stage, the process of excessive blood coagulation is started, as well as the aggregation of cells inside the vessels. An excess amount of thromboplastin, or a substance with a similar effect, is released into the blood. This starts the folding processes. The time of the initial stage can vary widely and take from a minute to several hours if the syndrome develops acutely. From several days to several months, the pathological process will proceed if the syndrome is chronic.
- The second stage is characterized by the start of the process of consumption coagulopathy. At the same time, a lack of fibrogen, platelets and other plasma factors responsible for the blood coagulation process increases in the body.
- The third stage is critical. At this time, secondary fibrinolysis occurs, blood coagulation reaches a maximum, up to a complete stop of this process. In this case, hemostasis is largely unbalanced.
- The recovery stage is characterized by the normalization of hemostasis. Residual dystrophic-necrotic changes are observed on organs and tissues. Another end of the DIC syndrome can be acute failure of one or another organ.
In full measure, the development of DIC syndrome (its severity and mechanism of development) depends on the degree of impairment of blood microcirculation and on the degree of damage to organs or their systems.
Symptoms of DIC
The symptoms of DIC will be determined by the clinical manifestations of the disorder that provoked its development. They also depend on how quickly the pathological process develops, in what state are the mechanisms responsible for compensating for hemostasis, and also at what stage of the DIC syndrome the patient is.
Symptoms of acute disseminated intravascular coagulation
- In the acute form of DIC syndrome, the pathological process quickly spreads throughout the body. Most often this happens in a few hours.
- The person is in a state of shock, his blood pressure drops to the border of 100/60 and below.
- The patient loses consciousness, symptoms of acute respiratory failure and pulmonary edema are observed.
- Bleeding increases, profuse and massive bleeding develops. This process involves such systems and organs of the human body as: the uterus, lungs, organs of the digestive tract. The development of nosebleeds is possible.
- Against the background of acute disseminated intravascular coagulation syndrome, destructive destruction of the tissues of the pancreas with the development of functional organ failure is observed. Possible accession of gastroenteritis of an erosive and ulcerative nature.
- In the myocardium, foci of ischemic dystrophy appear.
With amniotic fluid embolism, DIC syndrome develops with lightning speed. In a few minutes, the pathology goes through all three stages, making the condition of the woman in labor and the fetus critical. Patients undergo hemorrhagic and cardiopulmonary shock, which can be difficult to stop. In this regard, the prognosis for life is unfavorable and death occurs in 80% of cases.
Symptoms of subacute disseminated intravascular coagulation
- The course of the syndrome in this case is more favorable.
- Hemosyndrome is expressed in the occurrence of hemorrhagic rashes.
- Bruises and large bruises may appear on the skin.
- Injured areas, injection sites are characterized by increased bleeding.
- The mucous membranes are also prone to bleeding. Blood impurities can be present in sweat and tears.
- The skin is characterized by excessive pallor, up to marbling. An unnatural coldness is felt when the skin is touched.
- The internal organs swell, fill with blood, necrosis areas, hemorrhages appear on them. The organs of the gastrointestinal tract, liver and kidneys, as well as the adrenal glands and lungs are subject to pathological changes.
As for the chronic form of DIC, it is not only found more often than others, but in most cases it is hidden. The patient, due to the absence of symptoms, may not even be aware of the development of pathologies in the hemostatic system. However, as the disease progresses, which provoked DIC, its symptoms will become more pronounced.
Other symptoms
Other symptoms that may indicate the development of DIC-syndrome of a chronic course:
- Deterioration and lengthening of the regeneration process of any wounds.
- Aggravation of asthenic syndrome with a corresponding symptom complex.
- Accession of a secondary purulent infection.
- Formation of scars on the skin in places where there was damage.
Complications of disseminated intravascular coagulation
Complications of DIC syndrome are usually very severe and threaten not only health, but also the patient's life.
More often than others, the following conditions develop:
- Hemocoagulant shock. Organs and tissues begin to experience oxygen deficiency, since microcirculation of blood is disturbed in the small vessels responsible for their nutrition. In addition, the amount of toxins in the blood itself increases. As a result, the patient's pressure drops sharply, both arterial and venous, organ failure, shock, etc. join.
- Acute respiratory failure. It is a borderline condition that directly threatens the patient's life. As hypoxia intensifies, loss of consciousness occurs, convulsions develop, and a hypoxic coma sets in.
- Acute renal failure is another common complication of DIC. The patient stops urinating, up to the complete absence of urine output. The water-salt balance is disturbed, the level of urea, nitrogen, creatinine increases in the blood. This condition is potentially reversible.
- Liver necrosis.
- From the digestive tract: stomach ulcer, intestinal infarction, pancronecrosis.
- From the side of the cardiovascular system - ischemic stroke.
- From the side of the hematopoietic system - hemorrhagic anemia in acute form.
Diagnosis of disseminated intravascular coagulation
Diagnosis of disseminated intravascular coagulation is based on the examination of the patient, taking anamnesis and conducting laboratory tests.
The patient is required to pass the following tests:
- UAC;
- OAM;
- Blood smear;
- Blood for a coagulogram, as the main method for diagnosing hemostasis (platelets, fibrogens and other important indicators are counted);
- ELISA (determination of PDP, RFMK, D-dimer, as the main markers of blood coagulation inside the vessels):
- Blood for paracoagulation tests (allow you to confirm or deny the diagnosis).
The doctor finds out the reason that led to the development of DIC, determines its stage and nature.
If the course of the syndrome is latent, then hypercoagulation can be determined solely by laboratory test data. In this case, fragmented erythrocytes will be present in the blood smear, thrombosed time and APTT will increase, the concentration of PDP will increase. A blood test will indicate a lack of fibrinogen and platelets in it.
If the syndrome is confirmed, then the most vulnerable organs are necessarily examined: kidneys, liver, heart, brain, lungs, adrenal glands.
Treatment of disseminated intravascular coagulation
Treatment of disseminated intravascular coagulation (DIC) is a rather complicated process; the patient does not recover in every case. If an acute form of the syndrome is diagnosed, then death occurs in 30% of cases, which is a fairly high indicator. However, it is not always possible to establish the exact reason why the patient died. Did the disseminated intravascular coagulation become a critical condition, or did the patient die as a result of the negative effects of the underlying disease?
Doctors who observe DIC syndrome, first of all, make efforts to eliminate or minimize the factor that led to the development of the syndrome and stimulates its progression. It is important to eliminate purulent-septic conditions, which most often provoke a violation of hemostasis. At the same time, it makes no sense to wait for the results of bacteriological studies, therapy is carried out in accordance with the clinical signs of the disease.
Antibiotic therapy against the background of disseminated intravascular coagulation is indicated in the following cases:
- Postponed abortion;
- Premature discharge of amniotic fluid, especially when they are not transparent and there is turbidity in them;
- Increase in body temperature;
- Symptoms indicating inflammation of the lungs, urinary tract, and abdominal organs;
- Signs of meningitis.
For treatment, antibacterial drugs of a wide spectrum of action are used, with the inclusion of γ-globulins in the treatment regimen.
For relief of shock conditions, injections of saline solutions, plasma transfusion with Heparin, Prednisolone (intravenously), Reopolyglucin are used. If the shock syndrome is eliminated in a timely manner, it is possible to stop the development of DIC, or significantly mitigate its manifestations.
As for Heparin, when it is administered, there is a risk of bleeding. It has no positive effect if it is used late. It should be introduced as early as possible, strictly observing the recommended dosage. If the patient is in the third stage of the development of DIC, then the introduction of Heparin is a direct contraindication. Signs indicating a ban on the use of this drug are: a drop in pressure, bleeding (it may be hidden), hemorrhagic collapse.
If the syndrome has just begun to develop, then the introduction of a-adrenergic blockers is indicated: Dibenamine, Phentolamine, Thioproperazine, Mazheptil. The drugs are administered intravenously at the required concentration. They contribute to the normalization of microcirculation in organs, resist the formation of blood clots inside the vessels. Do not use epinephrine and norepinephrine medications as they can worsen the situation.
With the formation of renal and hepatic failure, in the early stages of the development of DIC, it is also possible to use drugs such as Trental and Curantil. They are administered intravenously.
At the third stage of development of DIC syndrome, it is necessary to administer protease inhibitor drugs. The drug of choice is Contrikal, the route of administration is intravenous, the dose is no more than 100,000 IU at a time. If necessary, the infusion can be repeated.
Local effects are reduced to the treatment of bleeding erosions, wounds and other areas using Androxon at a 6% concentration.
Summing up, it can be noted that the complex treatment of DIC syndrome is reduced to the following points:
- Elimination of the root cause that provoked the development of the syndrome.
- Anti-shock therapy.
- Replenishment of blood volumes with transfusion of plasma enriched with Heparin, if there are no contraindications to this.
- Early use of adrenergic blockers, and drugs that help reduce the number of platelets in the blood: Curantil, Trental, Ticlodipine.
- Introduction Contrikal, platelet transfusion to normalize hematocrit against the background of severe bleeding.
- Prescribing plasmacytaparesis, if indicated.
- To normalize microcirculation in the affected organs, nootropics, angioprotectors and other post-syndromic drugs are used.
- With the development of acute renal failure, hemodiafiltration and hemodialysis are performed.
Patients with DIC syndrome are hospitalized without fail and are under round-the-clock supervision of doctors. They are located either in the intensive care unit or in intensive care units.
As for the forecast, it is very variable. To a greater extent, it depends on what caused the development of DIC, on the degree of hemostasis disturbance, on how quickly first aid was provided and how adequate it was.
A lethal outcome cannot be ruled out, since it can occur against the background of profuse blood loss, shock, organ failure.
Physicians should pay special attention to patients belonging to risk groups - the elderly, pregnant women, newborns, people with underlying diseases.
Author of the article: Alekseeva Maria Yurievna | Therapist
Education: From 2010 to 2016 Practitioner of the therapeutic hospital of the central medical-sanitary unit No. 21, city of elektrostal. Since 2016 she has been working in the diagnostic center No. 3.
