cid prez rezidenti

8/18/2019 Cid Prez Rezidenti

1/25

COAGULAREA INTRAVASCULARADISEMINATA

Def: proces patologic caracterizat prinacti area intra asc!lara generalizata a"ecanis"elor #e"ostatice generan$ for"areafi%rinei& acti area fi%rinolizei si cons!"!lplac#etelor si al factorilor coag!larii


2/25

'iziopatologie

() E*p!nere $e 'actor Tis!lar+tra!"atis"e& ars!ri& c#ir!rgie$ela%ranta,

-) Lezi!ni en$oteliale +en$oto*ine&cito.ine,

/) Eli%erarea enzi"elor proteolitice in

sange +pancreatita& enin serpi,0) Tro"%oze "asi e1) 2ipo*ie se era& aci$oza


3/25


4/25

ETIOLOGIE

3 Lezi!ni tis!lare3 Co"plicatiile sarcinii +a ort sepric& $ezlipirea $e

placenta& e"%olia a"niotica,3 Neoplazii +carcinoa"e& le!ce"ii ac!te,3 Infectii +sepsis 4 ger"eni G5& iroze& "icoze,3 6oli asc!lare +t!"ori asc!lare& ane ris"e&

#e"angioa"e gigante& IMA& TE7& 2TA "aligna&c#ir!rgie c ,

3 Ca!ze i"!nologice + asc!lite& soc anafilactic,

3 2e"oliza intra asc!lara +transf!zii inco"pati%ile&27N,3 Soc!l& #ipoter"ia& tra!"atis"e se ere&

pancreatita ac!ta& aci$oza $ia%etica& stat!s

epileptic


5/25

Etiologia CID


6/25

CLINIC

3 CID ac!t:5 acti are rapi$a a coag!larii 895a fi%rinolizei

5 e ol!tie rapi$a +ore, 5 #e"oragii "asi e3 CID cronic:5 cons!" lent al factorilor

coag!larii 5 frec ent asi"pto"atic sa!

asociat c! tro"%oze


7/25

Cascada coagularii


8/25


9/25


10/25

'i%rinoliza pri"ara si sec!n$ara


11/25


12/25

Mar.erii acti arii coag!larii+generarea tro"%inei,

3 'rag"ent!l ()-3 '7A& '763 C* TAT


13/25

Mar.erii acti arii fi%rinolizei

3 'rag"ent!l 6 β (50-3 TM'83 7D'83 D5$i"eri8 +fi%rinoliza sec!n$ara, -;;; ng9"l3 C* 7A73 TLCE3 7las"inogen3 7las"ina


14/25

Cons!"!l in#i%itorilor

3 AT III3 Alfa-5antiplas"ina

3 Cofactor II 2ep3 7r C3 7r S

3 C* TAT3 C* 7A7


15/25

CID –diagnostic de laborator 3 Elemente de atentionare :

5 eritrocite frag"entate +sc#izocite, +1; calea e*trinseca5a7TT > calea intrinseca +sa! N9 la $e%!t

sa! CID cr,5'i%rinogen&+ V& ?III,5TLCE5TTr +$atorita '%g si 7D'8,


16/25

3 Ele"ente $e precizare:a) acti area coag!larii +for"area tro"%inei,

'rag"ent!l ()-'7A& '76

AT IIIC* TAT 8 +sepsis,

%) acti area fi%rinolizei +for"area plas"inei,7las"inogen7las"ina7D'8TM'8D5$i"eri8 +fi%rinoliza sec!n$ara,α - antiplas"inaC* 7A7 8 +sepsis,

'rag"ent!l Ββ 1−42


17/25

Diagnostic diferential3 PTT : Ane"ie #e"olitica "icroangiopatica

Tro"%ocitopenieDAR: teste $e coag!lare nor"ale

3 Sd Evans : A2AI 8 Tro"%ocitopenie i"!na DAR: teste $e coag!lare nor"ale

3 Insuficienta hepatica :a7TT&INR 5 prel!ngite 895 'i%rinogen

895 tro"%ocitopenie &ane"ieDAR: $5Di"eri 59!sor & conte*t clinic&

TGO&TG7&6R&al%!"ina& Colesterol etc


18/25

3 Fibrinoliza primara : se"nele $e acti are afi%rinolizei c! acti!nea plas"inei as!pra 'i%rinogen!l!i$ar fara generare $e tro"%ina sa! fi%rina + D-dimerineg ,

3 Deficitul de itamina ! +o%str!ctii %iliare&anti%ioterapiec! spectr! larg la pacienti in star atie&rezectiiintestinale,

II" II" I#" #" PrC" PrS aPTT"$PDAR: Tr>N& 2%>N& '%g>N& D5$i"eri > a%senti

3 Tratamentul anticoagulant% 2eparina nefractionata ins!pra$oza@ 895 ACO

DAR: Tr>N9 & '%g>N& D5$i"eri5


19/25

Alte ele"ente $e $g $iferential

3 7D': 8 in ane"ii #e"olitice "icroangiopatice+7TT& S2U, $ar fara alte t!l% $e cgl in#epatopatii +ciroza 8 fi%rinogenoliza8 VII si I? ,

$ar $5Di"eri5 in TE7 in !re"ie3 Tro"%ocitopenia $!pa circ e*tracorporeala

9#e"o$ializa 9 intretinerea cateterelor 8 ano"alii$e cgl $atorate 2eparinei


20/25

Tratament() I$entificarea si in$epartarea ca!zei

-) Terapie s!porti a +repletie ole"ica& A6& MER,/) Terapie s!%stit!ti a: Criopp +(U>-1;"g '%g&

/g '%g cresc '%g plas"atic c! (;;"g9$l,77C& 895 CT +$aca TrB1;;;;9""c si #r,

0) 2eparina9LM 2 in CID cronic& LA7&carcinoa"e& p!rp!ra f!l"inans& tro"%oza"arilor ase& "icrotro"%oze renale& afecti!niale sarcinii

1) ATIII in soc septic si necroza #epaticaf!l"inanta


21/25

CID in LA7

In special in arianta #ipergran!lara

Etiologie "!ltifactoriala:5 'T $in gran!lele 7ro5 proteaze5 ane*ina II +receptor pr plas"inogen si t57a fi%rinoliza,

5 acti atori ai plas"inogen!l!i $in gran!leCID cronic progresi c! fi%rinoliza sec se"nificati a sa!CID ac!t agra at $e terapieTrata"ent: Cpp +'%gB(;;"g9$l,& CT +TrB -;;;;9"" / ,&77C +7T si a7TT 8 2r,) Daca '%g n! poate fi "entin!tsi9sa! 7D' cresc 2eparina 1;;U9#) Daca - 5antiplas"ina "ica EACA c! "onitorizare - 5antiplas"ina) ATRA si AsO/ a"elioreaza net coag!lopatia


22/25

'i%rinogenoliza

Etiologie: #epatopatii se ere& neoplas"e !rogenitale+!ro.inaza ,& LA7& postapart!"& % pass& cla"parea Ao+prin #ipo*ie si #ipoperf!zie acti eaza plas"inogen!l,&$eficite $e 7AI5( si - 5antiplas"ina)

'izpat: plas"ina li%era in circ!latie ce $epaseste capac

$e ne!tralizare $e catre antiplas"ine) 7las"inaproteoliza '%g 8 nespecifica pe VIIIc& ?III& acti eaza%ra$i.inina +#ipoTA,Clinic: #e"oragiiLa%orator : '%g & TTr & 7T> N9 & a7TT> N9 & V>N9 &VIIIc>N9 & ?III>N9 & 7D'8 & 7las"inogen & 7las"ina& - 5antiplas"ina & $5Di>N& '7A 5 & 7A78& Tr>N

Trata"ent: EACA& ac trane*a"ic DAR TRE6UIEE?CLUS CID


23/25

3 Tr>(;;;;9""c3 2%>F& g9$l3 Rt>-<3 'roti!: eritrocite in r!lo!ri&

frec ente sc#izocite3 LD2>/-; U9L

3 6RT>-&H"g9$l3 6RI>(&F"g9$l3 a7TT> (sec3 A7>-/<

3 '%g>(/;"g9$l3 D5$i"eri 8883 Dg>

3 Tr>(/;;;;9""c3 2%>(;&1g9$l3 Rt>(&H<3 LD2>-F; U9L3 6RT>(& "g9$l3 6RI> (&; "g9$l

3 a7TT>0;sec3 A7>01<3 '%g>-/;"g9$l3 D5$i"eri 83 Dg>


24/25

3 Tr>(11;;;9""c3 2%>(;&-g9$l3 Rt>-&/<

3 VEM> 1 fl3 'e>-0 µg9$l3 CTL'>0J µg9$l3 6RT>(&("g9$l3 a7TT>/F&H sec3 INR>(&J3 '%g>HF "g9$l3 7D' 8883 D5$i"eri5

3 TLCE3 'roti!: "icrocite&rare erpolicro"atofile& f raresc#izocite

3 Dg>

3 Tr>-;;;;9""c3 2%> &-g9$l3 Rt>(-<

3 VEM>FF fl3 'e>(01 µg9$l3 CTL'>-(/ µg9$l3 6RT>0&-"g9$l3 6RI>/&-"g9$l3 LD2>((0F U9L3 a7TT>- sec3 INR>(&-3 '%g>1 1"g9$l

3 D5$i"eri 43 'roti!:f frec ente

sc#izocite& er $isp!se inr!lo!ri& E%l>(9(;;


25/25

3 2%>F&(g9$l3 Rt>0&J<

3 Tr>(F;;;9""c3 'roti!:"icrosferocite&

sc#izocite3 a7TT>F sec3 INR>/&13 '%g> (H;"g9$l3 TLCE>/;"in3 D5$i"eri8883 ATIII>-;<3 Dg>

3 2%>1&Hg9$l3 Rt>(-<

3 Tr>1;;;9""c3 'roti!: "icrosferocite&rare sc#izocite

3 6RT>0&-"g9$l

3 6RI>/&-"g9$l3 a7TT>-0sec3 INR>(&/

3 '%g>/FH"g9$l3 D5$i"eri8953 TCD 888 +IgG,3 Dg>

cid prez rezidenti

Documents