Disseminated Intravascular Coagulation Essay

1004 words - 5 pages

Disseminated Intravascular Coagulation (DIC) is a complex and progressive multisystemic hemostatic malfunction effecting canines, felines, humans, and other animals (Hackner). DIC is significantly more common in canines than in felines, but the mortality rate in felines is much higher, 93% versus 50-77% in canines (Bruchim, Hackner). This fatal syndrome is not a specific disease but a secondary complication of an underlying disorder (Bruchim). Marked by excessive intravascular coagulation leading to organ microthrombosis and inadequate organ tissue perfusion, DIC may also paradoxically affect clotting factors and platelet consumption, leading to excessive bleeding (Tilley 372, Nelson 1203). ...view middle of the document...

The acute consumptive phase is most common in dogs with chronic disorders; it is very rare in felines; this is the phase most associated with excessive or spontaneous bleeding (Bruchim).
The challenge for clinicians is to diagnose DIC early in the silent or hypercoagulability phases of the syndrome where outcomes are most positively affected by treatment (Hackner). Because DIC can be difficult to diagnose, it should be suspected in any patient presenting with disease processes linked to DIC, and testing should be performed immediately and frequently in these cases (Hackner). Unfortunately, there are no specific ELISA or laboratory tests for DIC diagnosis; diagnosis is based on history and laboratory test results, combined with a practitioner’s knowledge and understanding of the primary diseases which trigger this deadly syndrome (Bruchim). Laboratory tests which may assist in making a diagnosis are a manual differential (thrombocytopenia is common, and macroplatelets and schistocytes are associated with DIC), biochemical analysis (azotemia, acidosis, and high enzymes may be related to DIC and its primary diseases), latex agglutination test for FDP or D-dimers (though D-dimers are not sensitive in felines), and practical assays which confirm depletion or clotting factors may also be helpful (Tilley 372, Hackner).
Once a diagnosis of Disseminated Intravascular Coagulation (DIC) has been established, experts agree that aggressive and effective treatment of the underlying disease or malady is the patient’s best hope for survival (Hackner). Currently, there are no controlled clinical studies evaluating the effects of specific therapies for dogs and cats suffering from DIC, therefore treatments vary and are sometimes controversial (Nelson 1204, Burchim). For example, heparin therapy has long been the mainstay for treatment of DIC but has recently been a source of debate among veterinary professionals; it has been suggested that the effects of the anticoagulant drug may be ineffective depending on which stage of DIC the patient is in and the underlying disease (Bruchim). In fact, studies of septic human patients with DIC who were treated with heparin reflected a higher mortality rate than patients who did not receive heparin therapy (Hackner).
Blood component therapies including fresh whole blood, fresh plasma or fresh frozen plasma...

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