基础医学各论：14.凝血障碍和DIC.pptVIP

Obstetrics The placenta and uterine contents are rich sources of Tissue factor Other procoagulants that normally are excluded from the maternal circulation -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment DIC Clinical manifestations of DIC may accompany obstetric complications, especially in the third trimester. These syndromes range from Acute, fulminant, and often fatal DIC in amniotic fluid embolism Blood is exposed to large amounts of tissue factor in a short period of time creating large amounts of thrombin Multiorgan failure Chronic or subacute DIC with a retained dead fetus. Exposure to small amounts of tissue factor -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment DIC Other obstetric problems associated with DIC include Abruptio placentae Toxemia Septic abortion. DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment Clinical manifestations Determined by Nature Intensity Duration of the underlying stimulus. Chronicity Low-grade DIC is often asymptomatic Diagnosed only by laboratory abnormalities. Bleeding is most common clinical finding Generalized or widespread ecchymoses Chronic disease Thrombotic complications Trousseaus syndrome in cancer Gangrene of the digits or extremities Hemorrhagic necrosis of the skin Purpura fulminans Enhanced by Coexistence of liver disease -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment DIC Diagnosis of severe, acute (easy) Prolongation of PT, aPTT and Thrombin time Due to consumption and inhibitiion of clotting factors Thrombocytopenia Fibrin degradatin products Increased due to secondary fibrinolysis Measured by latex agglutination or D-dimer assays. Schistocytes may be seen in the peripheral blood smear Neither sensitive nor specific for DIC. DIC -Background -Pathophysiology -Etiology -Clinical Manifestations -Diagnosis -Treatment Chronic or compensated forms