How we manage haemostasis during sepsis.

Area of Science:

• Hematology
• Critical Care Medicine
• Pathophysiology

Background:

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
• Sepsis can activate the coagulation system, potentially leading to disseminated intravascular coagulation (DIC).

Purpose of the Study:

• To explore the relationship between sepsis and coagulation system activation.
• To discuss the progression from thrombotic to bleeding states in sepsis-induced DIC.
• To highlight the role of scoring systems and laboratory parameters in diagnosing DIC.

Main Methods:

• Review of the pathophysiology of sepsis-associated coagulation abnormalities.
• Analysis of clinical features, including thrombocytopenia and hypofibrinogenemia.
• Discussion of diagnostic scoring systems for DIC.
• Consideration of hemostatic support strategies.

Main Results:

• Sepsis initially causes thrombosis in small and medium vessels, leading to organ dysfunction.
• Continued coagulation activation consumes factors, prolonging coagulation parameters and causing thrombocytopenia.
• Severe cases involve hypofibrinogenemia and fibrinolytic overactivation, resulting in a bleeding phenotype.

Conclusions:

• Disseminated intravascular coagulation (DIC) is a severe complication of sepsis, characterized by a shift from thrombosis to bleeding.
• Routine laboratory parameters and scoring systems aid in DIC diagnosis and risk assessment.
• Management involves supporting hemostasis through medical and blood product interventions.