Diseminirana intravaskularna koagulacija (DIK): rana dijagnoza doprinosi uspješnom liječenju
Benjamin Brainard, VMD, DACVAA, DACVECC, Professor
Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens GA, USA; e-mail: email@example.com
Izvor: Knjiga sažetaka 3. međunarodnog veterinarskog specijalističkog simpozija “Hitna i intenzivna skrb u veterinarskoj medicini”
Non-overt DIC is the description of early DIC, before consumption has resulted in hemorrhage. Non-overt DIC is not only a treatable condition, but should be an indication to the clinician to identify a source of inflammation in the patient. While overt (hemorrhagic) DIC is characterized by a platelet count between 40-80 x 109/L, unmeasurable coagulation times (prothrombin [PT] and partial thromboplastin times [aPTT]), and low plasma fibrinogen concentration, non-overt DIC is characterized by a decreasing platelet count (40-100 x 109), with normal plasma fibrinogen concentration, normal PT, and only a mild prolongation of aPTT (1.5 -2 times normal values). When non-overt DIC is diagnosed, therapeutic workup should focus on identifying and treating the source of the inflammation. This may include imaging studies with radiography and ultrasonography (both abdominal and cardiac), assessment of organ function through serum biochemistry and urinalysis, serological studies for infectious diseases, and fine needle aspirates or biopsies of abnormalities. In particular, it is important to rule out the possibility of infection as a cause of the inflammation, and in some patients, culture of urine and blood may be indicated. If infection is highly suspected, it is reasonable to start treatment with broad spectrum antibiotics while further diagnostic tests progress. In the author’s experience, the most common sites of infection that can result in non-over DIC include heart valves (endocarditis), urinary tract (pyelonephritis), and the liver (cholangiohepatitis).
Treatment of DIC is primarily supportive and can include intravenous crystalloid fluid therapy, antibiotics, oxygen in certain cases, and close monitoring of hematocrit, urine output, blood pressure, and blood oxygen content. Especially in non-overt DIC, anticoagulant treatment is not necessary, and resolution of the initial inflammatory problem is suitable to reverse the coagulopathy. Once DIC has progressed to a hemorrhagic disease, transfusions with fresh frozen plasma to normalize coagulation times and red blood cells to support hematocrit may be indicated, in addition to treatment of the initial inflammatory process.
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