1 / 21

Disseminated Intravascular Coaggulation and Purpura Fulminans

Disseminated Intravascular Coaggulation and Purpura Fulminans. Robert Lampman, MD Morning Report May 2010. The next series of 3 slides have figures that have been shamelessly borrowed/modified from a presentation by Dr Elizabeth Bengston of Dartmouth Medical School.

mckile
Download Presentation

Disseminated Intravascular Coaggulation and Purpura Fulminans

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Disseminated Intravascular Coaggulation and PurpuraFulminans Robert Lampman, MD Morning Report May 2010

  2. The next series of 3 slides have figures that have been shamelessly borrowed/modified from a presentation by Dr Elizabeth Bengston of Dartmouth Medical School.

  3. Kumar: Robbins and Cotran Pathologic Basis of Disease, Professional Edition , 8th ed.

  4. DIC – The Pathophysiology • Paroxysmal or insidious onset of widespread fibrin thrombi in the microcirculation • Widespread thrombi formation results in platelet and coagulation protein consumption • Simultaneous activation of fibrinolytic mechanism • Thrombotic disorder -> Bleeding catastrophe Kumar: Robbins and Cotran Pathologic Basis of Disease, Professional Edition , 8th ed.

  5. DIC - 2 Pathways of Activation • 1. Tissue Factor or thromboplastic substance release into circulation. • obstetrics, malignancy, trauma, surgery, tissue necrosis • 2. Endothelial Injury - collagen exposure • endotoxin, bacteria, virus, burns

  6. 4th Edition 1901

  7. Purpura Fulminans • “Purpura fulminans is characterized by the rapid progression of ecchymotic skin lesions, especially of the extremities, that may progress to gangrene, ultimately resulting in amputation.” • Rare and more often seen in children • Post infection: scarlett fever, varicella, URI (meningococcus) • Appears 0-90 days post infection Hoffman: Hematology: Basic Principles and Practice, 5th ed.

  8. Purpura Fulminans - Pathophysiology • Most Accepted Explanation: Deficiency of Anticoaggulants • Acquired Protein S def, Anti-Protein S Antibody • Low levels Activated Protein C -> low levels Protein C, protein S, and antithrombin (thrombomodulin-PrC pathway) Hoffman: Hematology: Basic Principles and Practice, 5th ed.

  9. DIC - Treatment • FFP to keep the INR <2 • Cryoprecipitate to keep the Fibrinogen level >100 • ATIII Concentrates - KyberSept trial, a double-blind placebo-controlled trial of the use of ATIII concentrates in 2300 adults with sepsis, found no difference in mortality at day 28 after diagnosis. • Heparin low dose – Controversial. Ad hoc retrospective analysis shows benefit equal to “treatment” arms of study.

  10. DIC / Purpura Fulminans - Treatment • APC concentrates – Very Controversial. • phase II trial: protein C concentrate for Tx of sepsis and purpura fulminans in children. Dose-dependent activation of protein C and normalization of coagulation imbalances. Not powered to detect mortality differences, none seen. • PROWESS vs ADDRESS trials for sepsis • Summary: 24hrs onset, multiorgan failure (SOFA scale etc), APACHE II >25

  11. References • Toussaint S, Gerlach H. Activated protein C for sepsis. N Engl J Med. 2009 Dec 31;361(27):2646-52. • Hoffman: Hematology: Basic Principles and Practice, 5th ed. • Kumar: Robbins and Cotran Pathologic Basis of Disease, Professional Edition , 8th ed. • Osler W. Principles and Practice of Medicine. 4th Edition. D. Aplleton and Company. New York. 1901. • Dr Elizabeth Bengston. Assistance Professor of Medicine, Hematology/Oncology. Dartmouth Medical School. Medical Student Lectures 2005. • Cornet AD, Smit EG, Beishuizen A, Groeneveld AB. The role of heparin and allied compounds in the treatment of sepsis. Thromb Haemost. 2007 Sep;98(3):579-86.

More Related