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[Therapy of consumption coagulopathies]
1Universitäts-Kinderklinik, Freiburg i.B.
Insights
Consumption coagulopathy, also known as disseminated intravascular coagulation, involves excessive clotting factor and platelet use. Early treatment of the underlying cause and circulatory support are crucial for managing this condition.
Area of Science:
- Hematology
- Pathophysiology
Context:
- Consumption coagulopathy and disseminated intravascular coagulation (DIC) are often used interchangeably.
- Both terms describe acquired blood clotting disturbances characterized by increased consumption of coagulation factors and platelets, leading to exhaustion of production sites.
Purpose:
- To elucidate the mechanisms and management of consumption coagulopathy/DIC.
- To emphasize the secondary nature of these disorders and the importance of treating the underlying cause.
Summary:
- Generalized activation of the hemostatic system initially causes hypercoagulability, followed by hypocoagulability and hemorrhagic diathesis.
- Microthrombi formation in the microcirculation is a key feature.
- Treatment focuses on addressing the underlying disease, restoring circulatory functions, and managing shock (hypothermia, acid-base/electrolyte imbalances, hypovolemia, anuria, uremia).
- Dextran can act as a plasma expander, correct hypercoagulability, and improve blood rheology.
Impact:
- Effective management relies on prompt and intensive treatment of the precipitating condition.
- Restoring circulatory function is key to resolving the coagulopathy.
- Anticoagulants or fibrinolytic drugs may be indicated if conservative measures fail to halt the consumptive process or restore microcirculation.
Abstract:
The terms "consumption coagulopathy" and "disseminated intravascular coagulation" are used synonymously, though the former expression refers to the process of consuming the haemostatic potential, whereas the latter is based upon the generalized formation of microthrombi. Both terms apply to an acquired disturbance of blood clotting leading to an increased turnover of coagulation factors and platelets by which the production sites are being exhausted. Such a process is triggered off by generalized activation of the haemostatic system: after a period of hypercoagulability, haemostasis changes into hypocoagulability with subsequent haemorrhagic diathesis. Additionally, the generalized activation of the haemostatic system leads to a formation of microthrombi in the microcirculation. Since consumption coagulopathies are bound to be secondary disorders, any underlying disease prone to lead to disseminated intravascular coagulation, should be treated as early and as intensively as possible. Solely by this and by restoring circulatory functions impaired by the underlying disease, it is possible in the majority of cases to stop the consumptive coagulopathy and to repair its sequelae. The shock frequently going along with a consumption coagulopathy requires immediate therapy: correction of hypothermia, treatment of acid-base and electrolyte disorders as well as fighting against hypovalaemia, anuria, and uraemia. Dextran does not serve only as plasma expander, but also corrects hypercoagulability and improves the rheological qualities of circulating blood. If these measures fail to stop the consumptive reaction of blood coagulation and/or fail to restore microcirculation in vital organs, indication for the use of anticoagulants or fibrinolytic drugs is given.(ABSTRACT TRUNCATED AT 250 WORDS)