0071643192.pdf

HEMATOLOGY, ONCOLOGY, ALLERGY,

AND IMMUNOLOGY

■ Prednisone 1–1.5 mg/kg/day
■ IVIG or anti-D immunoglobulin
■ Platelet transfusion is not normally indicated and should be limited to
patients with life-threatening hemorrhage.
■ Those unresponsive to steroids and IVIG may need splenectomy or immune
modulation therapy.

Disseminated Intravascular Coagulation

Disseminated intravascular coagulation is widespread activation of the coagu-
lationandfibrinolyticcascade leading to a life-threatening bleeding disorder.
Common causes are listed in Table 9.8.

SYMPTOMS/EXAM

■ Purpura, petechiae
■ Bleeding,involving skin, mucus membranes, venipuncture sites, surgical
wounds, GI tract, GU tract, CNS
■ Thrombosis,causing focal ischemia in areas of end circulation (extremi-
ties, nose, genitalia), mental status changes

DIAGNOSIS

■ Prolonged PT and aPTT, low platelet count, low fibrinogen level, elevated
fibrin degradation products, elevated D-dimer, increased thrombin time,
decreased antithrombin III levels
■ Schistocytes (from fibrin deposition in small vessels and resultant RBC
destruction) on peripheral smear

TREATMENT

■ Supportive care
■ Treat underlying cause.

ITP—IVIG, steroids

TTP—exchange transfusions

Infection is the most common

cause of DIC. Specific causes

include Gram-positive and

Gram-negative sepsis,

meningococcemia, typhoid

fever, and Rocky Mountain

spotted fever.

TABLE 9.8. Common Causes of DIC

Infection (bacterial, viral, fungal)

Carcinoma (adenocarcinoma, lymphoma, acute leukemia)

Trauma (burns, crush, head injuries)

Shock

Liver disease

Pregnancy (placental abruption, amniotic fluid emboli, fetal death in utero)

Envenomation

ARDS

Transfusion and drug reactions

Surgical procedures

Heat stroke