《中山大学法律评论》.ppt

Disseminated Intravascular Coagulation
(DIC)
【Change of basic pathology 】
Key change
This fine homeostatic balance of controlled thrombin generation is lost in DIC.
DIC represents a continuum in clinical – pathological severity, characterized by the increasing loss of localization pensated control in intravascular activation of coagulation.
It is characterized by the activation of the coagulation system with resultant consumption of a variety of coagulation proteins and platelets, which results in hemorrhagic diathesis and ischemic injury to various tissues.
Concept
Concept
Prothrombotic state
thrombotic state
Low consumption of coagulation status
Secondary fibrinolysis
Basic pathological process
Concept
Hypercoagulable state
Hypocoagulable state
Pathological features
Bleeding、Shock、MODF、Microangiopathic hemolytic anemia
1. Basic disease
Condition associated with DIC
Cause
Infectious disease---the mon clinical condition associated with DIC;
Severe trauma---acute DIC is often seen with serious injuries and burns caused by the release of thromboplastic material;
Neoplasia---both solid tumor and cancer;
Vascular disorder---large aortic aneurysms may result in local activation of coagulation;
Obstetric accidents---includes amniotic fluidembolism and placental abruption, the fetus, the placenta, and the amniotic fluid are rich in thromboplastic substances.
Normal hematostasis, fibrinolysis and PC system
K PK Ⅻa
collagen HK Ⅹa
ⅫⅫa
TF
ⅪⅪa Ⅶa Ⅶ
Ca2+ Ca2+
ⅨⅨ
Ⅷ

ⅩⅩ
ⅤⅩⅢ
Ca2+ Ⅹa、Ⅱa
F1+2 ⅩⅢa
Ⅱa Ⅱ Ca2+
FPA/FPB
Fbg FM Fbn
Intrinsic pathway
Extrinsic pathway
Ⅹa
Ⅴa
PL+Ca2+
Ⅸa
Ⅷa
PL+Ca2+
Blood coagulation
AT
TFPI
(-)
Blood coagulation
Monocyte-macrophage
Vascular endothelial cell(VEC)
Anticoagulation factors in plasma AT、TFPI
Protein C system
Fibrinolytic system
coagulation inhibitory systems
Cell anticoagulation system
Body fluid anticoagulation system
Blood coagulation
excessive generation of thrombin
defects in inhibitors