Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition, Q&A 05
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Student tip: This case is an example of practical application of theory. |
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| The Rule of 20 highlights coagulation as one of the important aspects to monitor in SIRS patients. What is disseminated intravascular coagulation (DIC)? | DIC is characterized by systemic activation of blood coagulation resulting in generation and deposition of fibrin, leading to microvascular thrombi. Severe bleeding may occur as the coagulation proteins are depleted. However, microthrombosis can occur without excessive consumption of coagulation factors and bleeding.
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| How is DIC diagnosed? | Diagnosis is difficult and no single routinely available laboratory test is sufficient. Diagnosis is based on presence of trauma or SIRS disease, low platelet numbers, prolonged PT/aPTT, decreased fibrinogen levels, increased fibrin degradation products, elevated D-dimers, schistocytes on blood smear, and decreased antithrombin and protein C.
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| How is DIC treated? | Treating the underlying disease, increasing capillary blood flow, and supporting target organs are the mainstays of therapy. Replacement of coagulation proteins, +/- platelets, is done to meet patient and procedural needs. Heparin is appropriate to treat the thrombotic stage of the disease but is ineffective without sufficient antithrombin. Administration of protein C has been of benefit to subgroups of humans with sepsis.
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