{"id":5834,"date":"2021-05-30T01:20:51","date_gmt":"2021-05-29T23:20:51","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/thrombocytopenia-and-platelet-disorders\/dic-and-hit\/"},"modified":"2021-05-30T14:27:00","modified_gmt":"2021-05-30T12:27:00","slug":"dic-and-hit","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/thrombocytopenia-and-platelet-disorders\/dic-and-hit\/","title":{"rendered":"DIC and HIT"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">DIC<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Sudden, widespread clotting within the microcirculation.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Platelets and clotting factors are \u201cconsumed\u201d (hence the synonym<strong> consumptive coagulopathy<\/strong>) due to the widespread clotting, causing an increased tendency of bleeding (hemorrhages)<\/li><li><strong>Small <\/strong>and<strong> medium vessels<\/strong> will clog, leading to ischemic tissue damage and necrosis (usually in the kidneys, brain, adrenal glands, and heart)<\/li><li>Externally, appears as diffuse petechiae and ecchymosis in the skin and mucosal tissues (including inside the body \u2014 GIT, urinary tract, and the serosal lining of body cavities and organs)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">In other words, there will be too much clotting in the wrong places and too little clotting in the right places.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Pathomechanism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\"><strong>Release of tissue factor<\/strong> and <strong>aggregation of platelets<\/strong> leading to <strong>widespread microvascular thrombosis<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The body will attempt to fix the situation by activating plasmin, fibrinolysis, and inhibiting the clotting factors, but it will only make things worse for the increased bleeding tendency (since the platelets and clotting factors were \u201cconsumed\u201d during the widespread clotting, as mentioned above).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>Obstetric complications<\/li><li>Malignant tumors<\/li><li>Bacterial infections (sepsis)<\/li><li>Autoimmune diseases<\/li><li>Physical or chemical traumas<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\"><strong>Complications<\/strong><\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">The microvascular thrombi can lead to infarcts in various organs. Depending on the severity, they may lead to abnormalities and even organ failure:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Destruction of the cortex in the kidneys<\/li><li><strong>Waterhouse-Friderichsen syndrome<\/strong>: in the adrenal glands (failure due to bleeding into the adrenal glands)<\/li><li>Bizzare neurological signs in the brain (may cause coma and death).<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Tests of hemostasis.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>The platelet count is low.<\/li><li>Fibrinogen concentration is low.<\/li><li>The thrombin time is prolonged.<\/li><li>High levels of fibrin degradation products such as D\u2010dimer are found in serum and urine.<\/li><li>Prolongation of PT and APTT<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Bleeding<\/strong>:<ul><li>FFP\/plasma concentrate; cryoprecipitate or fibrinogen concentrates provide more concentrated fibrinogen.<\/li><\/ul><ul><li>Red cell transfusions may be required.<\/li><\/ul><\/li><li><strong>Thrombosis:<\/strong><ul><li>Heparin or antiplatelet drugs to inhibit the coagulation process.<\/li><\/ul><\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Fibrinolytic inhibitors<\/strong> should not be used because of consequent failure to lyse thrombi in organs such as the kidney.<br><\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Heparin induced thrombocytopenia<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\"><strong>Heparin<\/strong><\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">Heparins are sulfated polysaccharide polymers that catalyze the binding of antithrombin III to clotting factors and inactivating them.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Indirect thrombin inhibitors<\/strong><\/li><li>Divided into<strong> unfractionated heparin<\/strong> (UFH), and <strong>low-molecular-weight heparin<\/strong> (LMWH, for example, <strong>enoxaparin<\/strong>)<ul><li>UFH is more potent against thrombin, can be monitored by APTT<\/li><\/ul><ul><li>LMWH has a longer half-life, safer, and is more potent against FXa<\/li><\/ul><\/li><li>Used IV\/SC in surgeries and acute cases requiring rapid anticoagulation.<\/li><li>It can be used in pregnancy (doesn\u2019t cross the placental barrier).<\/li><li><strong>LMWH <\/strong>is less likely than unfractionated heparin to cause HIT<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Heparin-induced thrombocytopenia<\/strong> is a life-threatening condition in which antibodies are produced against <strong>heparin-PF4<\/strong> (platelet factor 4, a soluble factor produced by platelets that binds to heparin) complexes, leading to <strong>massive platelet activation, thrombosis, and thrombocytopenia.<\/strong><\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Type one<\/strong><ul><li>Mild lowering of the platelet count may occur in the first 24 hours as a result of platelet clumping. This is of no clinical consequence<\/li><\/ul><\/li><li><strong>Type two<\/strong><ul><li>May occur in up to 5% of patients who are treated with unfractionated heparin and paradoxically presents with thrombosis.<\/li><li>It results from the binding of heparin to platelet factor 4<\/li><li>Followed by the generation of an IgG antibody to the heparin\u2013PF4 complex,<\/li><li>Leading to platelet activation, thrombocytopenia,<strong> <\/strong>and thrombosis.<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_10\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_10\">\n\n\n<ul class=\"wp-block-list\"><li>DIFFICULT<\/li><li>Presents as a fall of <strong>more than 50% <\/strong>in the platelet count<strong> 5 or more days<\/strong> after starting heparin treatment or earlier if heparin has been given previously<\/li><li>heparin\u2013PF4 complex assays<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_11\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_11\">\n\n\n<ul class=\"wp-block-list\"><li>Heparin therapy must be discontinued<\/li><li><strong>Argatroban<\/strong>, <strong>bivalirudin<\/strong>, or <strong>fondaparinux<\/strong> against thrombosis.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Warfarin therapy should not be started until <strong>normalization of the platelet count<\/strong> has been achieved.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">DIC<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Pathomechanism<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\"><strong>Complications<\/strong><\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Heparin induced thrombocytopenia<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\"><strong>Heparin<\/strong><\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>DIC Sudden, widespread clotting within the microcirculation. Platelets and clotting factors are \u201cconsumed\u201d (hence the synonym consumptive coagulopathy) due to the widespread clotting, causing an increased tendency of bleeding (hemorrhages) Small and medium vessels will clog, leading to ischemic tissue damage and necrosis (usually in the kidneys, brain, adrenal glands, and heart) Externally, appears as [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5575,"menu_order":10,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5834","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>DIC and HIT &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/thrombocytopenia-and-platelet-disorders\/dic-and-hit\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/thrombocytopenia-and-platelet-disorders\\\/dic-and-hit\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/thrombocytopenia-and-platelet-disorders\\\/dic-and-hit\\\/\",\"name\":\"DIC and HIT &#8211; 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