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Disseminated intravascular coagulation
B Risberg1, S Andreasson, E Eriksson
1Department of Surgery, Ostra Sjukhuset, University of Göteborg, Sweden.
Insights
This review details disseminated intravascular coagulation (DIC) pathophysiology, focusing on microcirculatory issues and endothelial dysfunction. It covers normal hemostasis, immuno-modulators, and treatment strategies for this critical condition.
Area of Science:
- Pathophysiology
- Hematology
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) involves complex pathophysiological events.
- Endothelial dysfunction and microcirculatory disturbances are key contributors to DIC.
- Normal hemostatic functions of the vascular endothelium are crucial for maintaining hemostasis.
Purpose of the Study:
- To describe the main pathophysiological events leading to disseminated intravascular coagulation (DIC).
- To emphasize the roles of microcirculatory disturbances and endothelial dysfunction in DIC.
- To discuss the interrelation between the endothelium, immuno-modulators, and proteolytic cascade systems.
Main Methods:
- Review of existing literature on DIC pathophysiology.
- Description of normal hemostatic functions of the vascular endothelium.
- Discussion of the connection between endothelium and immuno-modulators.
Main Results:
- Microcirculatory disturbances and endothelial dysfunction are central to DIC.
- The interplay between proteolytic cascades and the endothelium is critical.
- Differentiating local versus systemic events is important for understanding DIC.
Conclusions:
- DIC involves complex endothelial and microcirculatory dysfunctions.
- Understanding these mechanisms is vital for effective DIC management.
- Treatment cornerstones and essential laboratory tests for DIC are outlined.
Abstract:
This review encompasses a description of the main pathophysiological events leading to disseminated intravascular coagulation (DIC). Emphasis has been put on microcirculatory disturbances and endothelial dysfunction. The normal hemostatic functions of the vascular endothelium are described. The close connection between endothelium and superimposed immuno-modulators is stressed as is the interrelation between the proteolytic cascade systems in the blood. The importance of differentiating local and systemic events is discussed. Organ dysfunction in multiple organ failure (MOF) is exemplified by pulmonary insufficiency in the adult respiratory distress syndrome (ARDS). Essential laboratory tests of DIC are described as are the cornerstones of treatment.