pathology arising from the violation of blood coagulation factors is acquired due to the excessively formed blood cells with the functionality of the coagulation cascade. Due to violations of the functions of blood cells on the walls of blood vessels appear blood clots blood clots, so because of pathological process damaged organs and tissues, which enables increased internal vascular pressure, can also occur bleeding.
This pathological process is not an independent disease but a complication of already occurring disease, therefore, the pathology of DIC treatment is assigned depending on the occurrence of painful primary focus. In addition, this pathological process is expressed stronger if the underlying disease is severe leakage.
When the flow of this disease of stages of DIC-syndrome, the characteristics of which are specific violations of the clotting process and a specific clinical picture. Thus, in accordance with the data determined by various authors in the designation of a hypocoagulation phase, DIC quantitative indicators of stages vary in different limits. So, when the phase of hypercoagulability is determined by the stage I DIC. Continuing this phase, depending on the specific organism, as a result of personal activity indices of blood coagulation, and therefore for each person the duration of stage I DIC its. In addition, the development of this phase happens at a rapid pace accompanied by disseminated intravascular coagulation and severe shock.
The characteristics of the period of hypercoagulability include the activation of plasma systems blood stream, changing the state of aggregation of thrombocytes, erythrocytes and leukocytes, and impaired microcirculation in different organ tissues, due to blocking of blood vessels by fibrin and aggregates formed elements. In addition, during the flow phase of hypercoagulability possible the gradual development of the slow receipt of protrombinazy in small doses. Slow the flow there are cases of explosions and progressively developing DIC-syndrome in the future.
At the first stage of disseminated intravascular coagulation may be replaced by a locally restricted occurrence of this process and the process of thrombosis. In 1975 it was established that the pathology of DIC causes become visible only after serological analysis not only on platelet count but also on leukocytes. The first stage is determined by the fact that owing to the properties of white blood cells to release clotting factors and contribute to changing the aggregation state is observed videopredatory the process of interaction of platelets with the damaged vessel wall and, as a consequence, a clot.
Stage II DIC is a phase of hypocoagulation, hypercoagulation relief. This phase is consumed already beached in blood fibrinogen, XIII, V, VIII factors and other substances, procoagulants. During the flow stage II DIC the accumulation of pathological inhibitors of blood coagulation, including the phenomenon of the disintegration products of fibrin, which increases anticoagulation activity of blood.
Although in violation of the process of blood clotting important role of connecting in a complex heparin with fibrin in the bloodstream does not change the concentration of heparin. In addition, despite the fact that the pathology of DIC diagnosis is determined also activates the fibrinolytic system, which leads to the process of dissolution of blood clots. The occurrence of accompanying disorders, such as hemorrhagic syndrome, are not excluded.
III stage of DIC occurs in dependence of the process in the future, but there won’t be fatal. This stage is negotiable, so when it restores the organs and their functions, but the process is closely related to the degree of damage of these organs. In addition, after the III stage of DIC-syndrome, typically there comes a full recovery, but with the presence of various complications, severe, not associated with the pathology of disseminated intravascular coagulation. The number of complications observed phenomena renal, hepatic nedostatochnosti, neurological, cardiac and other changes.
The pathogenesis of DIC in the title role is emerging factors in the blood that trigger blood clotting or change its aggregation state on the cellular level. In the process of reproduction fabrics, surgical interventions that are associated with the technique of kneading bodies used in the husking of the adenoma in the prostate tissue and in the postpartum period for uterine massage in the blood of substances having similar properties to tissue thromboplastin. Similar action has and bacterial enzymes activating the blood coagulation process and change of the aggregation state of platelets. A similar effect on the body have all of the infection and vasculitis, and occurs stressful situation. In addition, in the bloodstream are released catecholamines and kinins, which have the same functions.
There are three factors, which activates intravascular blood clotting
- the external factor associated with the effect of emitted compounds in the bloodstream and tissue thromboplastin tromboplastinovoe substances
- internal factor appearing after contact with damaged vascular walls. Also DIC in pregnancy can be activated by immune complexes
- cell aggregation arising due to contact of platelets with the damaged vessel wall, a foreign body, as well as due to release of catecholamines or of the occurrence of thrombin.
There is another important factor that leads to DIC-syndrome is reduced indicators of the presence of antithrombin III in the blood. This substance is a major natural anticoagulant. Healthy people have fluctuations in the level of the substance is from 70% to 100%, but during the pregnancy, presence of infectious process or after the surgical intervention, the levels of antithrombin III may be reduced by 25%, so there is a risk of intravascular clotting.
Despite the fact that hypercoagulability syndrome can be eliminated independently, cancel treatment is impractical due to the fact that the patient is active are important rehabilitation therapy. It is from the presence of the rehabilitation depends on the manipulation of the final outcome.
In addition, in the characterization of TGS, there is another process. When the activation factors of the coagulation of the blood, in the same period is observed and activation of prostaglandins due to the release into the blood kallikrein, kinin, of fibrin. So, thrombohemorrhagic syndrome and these factors combine to disrupt the system of blood microcirculation. In addition, the disorder of hemodynamics determines the severity of pathology of DIC in children.
In 1978 he was selected stages of disorders of hemodynamics (DIC), the symptoms of which are the following
- at compensated stage there is hyperemia of the skin, hypertension, tachycardia. Also present phenomena of metabolic acidosis and increased hematocrit level by 0.68%. Typically, this stage occurs during the first phase of disseminated intravascular coagulation. In addition, the compensated phase is captured it is difficult in the case of pathology DIC clinic determines its rapid development
- subcompencirovanna stage has characteristic signs of Central circulation, there is pallor of the skin, the phenomenon of hemorrhagic rash and increase in diastolic blood pressure in arterial hypertension. Hematocrit is increased by 10%. In addition, the DVS-syndrome, the pathogenesis of which is determined by this stage in the transition between the first phase and the phase of hypocoagulation can cause disorder of the nervous system.
Characteristic of the decompensated phase has a paresis of the vessels of the periphery. Observed grayish-cyanotic skin color, lower blood pressure, but if there is pathology of DIC-syndrome in obstetrics, as a rule, it is a significant improvement. Patients at a decompensated stage include tachycardia, 2001 which exceeds a minute, or bradycardia, and may cause anuria and elevated body temperature, the progress of neurological disorders. As a result of laboratory tests is determined by the mixed acidosis and a decrease in hematocrit due to anemia. Stage of decompensation, as a rule, detected in the course of the phase of hypocoagulation in a deep degree.
Disseminated intravascular coagulation is a pathology, which is among the most difficult to diagnose dysfunctions. Therefore, for its computation, after the above medical interventions, or pregnancy, the Clinician should assign a direction to the laboratory for blood sampling to determine the presence of this disease. This is followed by a treatment that should be carried out depending on the main causes of DIC.
DIC treated difficult if the disease is in the acute form, about 30% of cases are fatal. Priority treatment is aimed at elimination of pathological processes that encourage the development of the syndrome. Applied therapy aimed at the elimination of purulent-septic processes, which often lie at the base of this syndrome. Patient requires early antimicrobial therapy, which is based on clinical indications. Important points in treatment of this syndrome is edema developing state of shock, rapid elimination which can assistance DIC, which began or to mitigate its course.