DIC - disseminated intravascular coagulation.TTP - thrombotic thrombocytopenic purpura

1.

DIC- DISSEMINATED INTRAVASCULAR
COAGULATION
TTP- THROMBOTIC
PURPURA
THROMBOCYTOPENIC
Dr Tzoran Inna
Thrombosis and Hemostasis Unit
Rambam Medical Center

2.

DICDISSEMINATED
INTRAVASCULAR
COAGULATION

3.

Widespread coagulation activation
Unregulated consumption of thrombocytes ad
coagulation factors
Bleeding or thrombosis

4.

5.

Bleeding is most frequent
Bleeding of skin and gastrointestinal tract
Thrombosis frequently associated with
malignancy

6.

DIC - REASONS
Sepsis
Gynecological catastrophe – abruptio placenta,
amniotic fluid emboli
Malignancy-APL
Multiple trauma
Burns
Hypertermia
Snake bite

7.

8.

CHRONIC DIC
Slow, sub-clinical course
Malignancy- prostata, pancrease
Intrauterine death
Aortic aneurism
Large hemangioma

9.

DIC- LABORATORY TESTS
Prolonged PT, PTT
Low fibrinogen
Low thrombocytes
High D-Dimers

10.

PLT
PT
PTT
RBC
Fragments
DIC
Low
Prolonged
Prolonged
+
Liver
Cirrhosis
Low
Prolonged
Prolonged
±
Massive
Bleeding
Low
Prolonged
Prolonged
±
TTP
Low
Normal
Normal
+++

11.

DIC - TREATMENT
Treatment of the precipitating factor
Bleeding treated with FFP, thrombocytes,
cryoprecipitate
Thrombosis treated with heparin, LMWH
Newest treatments
Activated Protein C
TFPI
Anti-thrombin

12.

TTP- THROMBOTIC THROMBOCYTOPENIC
PURPURA
von Willebrand factor (vWF) cleaving protease
ADAMTS 13 deficiency
Accumulation of large multimers of VWF

13.

14.

TTP
Clinical Syndrome
Thrombocytopenia
Hemolytic anemia
High LDH
Neurological symptoms
RBC fragments

15.

Inherited lack of ADAMTS13
Acquired antibodies to ADAMTS 13
- Gram neg bacteremia
- Pregnancy
- Drugs
- HIV
- Malignancy
- Organ or BM transplantation

16.

TTP- TREATMENT
Plasmapheresis with plasma or albumin
Rithuximab
Avoid thrombocytes infusion