DIC
Terms
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- What is DIC?
- It is a disease of small thromboses everywhere in the body that does not cause a symptom per se, but because of the consumption of normal clotting components, a deficiency develops and the patient starts bleeding from various sites.
- What symptom in the hands would make you think DIC?
- Dark fingernails.
- What two things could make DIC worse?
- DIC is worsened by acidosis and massive transfusion (when the patient requires the approximate same volume of blood his/her blood in blood transfusions in a 24 hour period).
- What is the main cause of DIC?
- A. Some of the most common causes of DIC are related to the release of tissue factor or tissue factor-like substance (i.e., thromboplastic substances) in circulation.
- What does tissue factor bind to?
- Factor VIIa
- What type of leukemia causes DIC?
- APL
- What does the initiation phase consist of?
- Tissue Factor combining with Factor VII leading to the activation of Factor X.
- What does the propagation phase consist of?
- Factors VIII and IX activating Factor X to help activate thrombin to form a clot and to activate Protein C.
- How does gram (-) bacteria cause DIC?
- LPS causes increased expression of Tissue Factor on the surface of the cells via TNF and IL-1 along with decreased expression of Thrombomodulin.
- When do you confirm DIC from laboratory tests?
-
1. High D-Dimers
2. Low Platelet count
3. Fragmented RBC (schistocytes)
4. Decreased Fibrinogen
5. Prolonged PT and PTT
6. Decreased levels of antithrombin, protein C, and protein S - Does fibrinogen have to be decreased to diagnose DIC?
- No
- What is a D-Dimer? What creates it?
-
1. Small part of a clot that is cleaved off curing clotting. Elevated D-Dimers mean elevated clotting.
2. Plasmin - What others things does plasmin do?
-
1. Makes D-Dimers
2. Cleaves Factors V, VII, IX, and high molecular weight kininogen
3. Activates platelets - What D-Dimer level is indicative of DIC?
- D-dimer level is much increased, >10,000ng/ml (normal range: 110-240ng/ml).
- In a DIC patient, what is their level of RDW like?
- It is elevated
- Prothrombin test mimics what? What is the reactant in the tube?
-
The initiation phase of clotting. Basically adding Tissue Factor to see how long it takes to start clotting?
Sodium Citrate - PT is really testing for activity in what factors?
- It is testing to see how factor VII is activating II, V, X, XI.
- PT is reliant on what factor the most?
- Factor VII
- PTT measures what phase? What factors are not involved in this?
-
Propagation (Intrinsic) phase
Factors VII - What factor is involved with hemophilia A?
- Factor VIII
- What factor is involved with hemophilia B?
- Factor IX
- What factor is involved with hemophilia C?
- Factor XI
- Protein C and S are both dependent on what Vitamin?
- K
- Anithrombin inactivates what factors?
- Antithrombin inactivates factors XIIa, XIa, Xa, IXa, IIa.