pathophysiologypartdic弥散性血管内凝血

1、1会计学pathophysiologypartdic弥散性血管内弥散性血管内凝血凝血2 The function of coagulation system (Extrinsic, Intrinsic pathway and platelet) The function of anticoagulation (TFPI, PC system, ATIII and fibrinolytic system) The regulation of balance by VECThe key factors for balance of coagulation-anticoagulation:34The

2、 fibrinolysis system Plasminogen (PLg)(Extra-activating pathway) (Intra-activating pathway) tissue-type plasminogen activation of clotting system activator (t-PA) XIa urokinase-type plasminogen thrombin activator (u-PA) XIIa XII(Exogenous activator) urokinase(UK) kallikrein (KK) streptokinase (SK )

3、prekallikrein(PK) Plasmin (Pln) Fbg Fbn FDP (fibrinogen) (fibrin) (Fbg/Fbn degradation products) 5Inhibit platelet aggregationFibrinolysisPrevent fibrinclot formationTraumaAdrenalinThrombinADPNO, PGI2 Xa, IIaPlasminPlasminoginActivatorst-PA, u-PAInactivateVa,VIIIaPSThrombinPC APCTMInhibit Xa, IIaAT

4、III+HeparinTFPIAnticoagulant function of endothelial cells67Todays Question Question 1. What is DIC?89extensive microthrombin extensive hemorrhage organ dysfunction Shock aneamiaNormal balance of coagulation-anticoagulationHypocoagulable stateHypercoagulable stateextensive activation of clotting fac

5、tors and platelets consumption of clotting factors and plateletssecondary fibrinolysishemorrhageorgan dysfunction Shock aneamia10An extensive activation of coagulation process caused by the entering of coagulation-promoting substances into circulationAn increased consumption of clotting factors and

6、platelets, deposition of fibrin and secondary fibrinolysis.results in11Etiologic Disease of DIC Diseases or pathologic process which may lead to DICTriggering Factor Any factors which may trigger or promote DIC occur12Triggering Factor Any factors which may trigger or promote DIC occurEtiologic Dise

7、ase of DIC Diseases or pathologic process which may lead to DIC1) Tissue injury and release tissue factor (TF) 2) Vascular endothelial cells (VEC) injury3) bacterial endotoxin4) Ag-Ab complex5) Protein hydrolytic enzymes6) Particle or colloid7) Virus and other microbe1314151617(2) Vascular endotheli

8、al cells injuryreleasing TF subendothelial exposureplatelets adhesion Aggregation and release18(3) Other pathway to activate clotting system19Deposit of FbnBlood condense, Viscosity2021Hypercoagulable stateHypocoagulable state22232425 PLn Thrombin Fbg (FI) FM sFbn Fbn 2627returned bloodto hearteffec

9、tive circulation blood volume peripheral resistanceheart function andcardiac output28MOD is usually the most important cause of death in DIC.29 Occurrence of MOD is related to following factors: (1) Extensive microthrombi formation in the organs ischemia, hypoxia, impairment of metabolism and functi

10、on, or even necrosis and organ failure. (2) Pathologic alteration caused by effects of organs each other DIC Lungs pulmonary circulation Heart hypoxia, acidosis Other organs (3) Pathologic alteration and symptoms of primary diseases (which should be rule out from MOD). inflammation of the lungs dysf

11、unction of respiration s e.g. Lung ARDS; kidney ARF; Digestive system nausea, vomiting, diarrhea, hemorrhage; Liver jaundice and hepatic failure; Heart CO, PAWP; Pituitary necrosis Sheehans syndrome; Adrenal cortex hemorrhagic necrosis Waterhouse-friderchsens syndrome; CNS bleeding, edema (somnolenc

12、e, coma, convulsion) 30 Occurrence of MOD is related to following factors: (1) Extensive microthrombi formation in the organs ischemia, hypoxia, impairment of metabolism and function, or even necrosis and organ failure. (2) Pathologic alteration caused by effects of organs each other DIC Lungs pulmo

13、nary circulation Heart hypoxia, acidosis Other organs (3) Pathologic alteration and symptoms of primary diseases (which should be rule out from MOD). inflammation of the lungs dysfunction of respiration s31 Occurrence of MOD is related to following factors: (1) Extensive microthrombi formation in th

14、e organs ischemia, hypoxia, impairment of metabolism and function, or even necrosis and organ failure. (2) Pathologic alteration caused by effects of organs each other DIC Lungs pulmonary circulation Heart hypoxia, acidosis Other organs (3) Pathologic alteration and symptoms of primary diseases (whi

15、ch should be rule out from MOD). inflammation of the lungs dysfunction of respiration32333435 (1) Mononuclear phagocyte system dysfunction3637(3) Hypercoagulable state 38(4) Disorder of microcirculation3940Exessive activation of clotting factors and formation of microthrombinIncreased consumption of

16、 clotting factors and plateletConsiderable formation of plasmin and FDP 41 Hypercoagulable Bleeding Bleeding markedly 42Shortened clotting and recalcification time; Increased adherence of plateletProlonged clotting and recalcification time Reduction of platelet count and Fbg narkedlyShortened CLT, E

17、LT; Prolonged TT 3P test (+), Increased FDP CLT = clot-lysis timeELT = euglobulin-lysis timeTT = thrombin time4344 2. Types of DIC According to the rate of development, divide into 3 types Acute Subacute Chronica few hours to dayswithin days to weeks months45 2. Types of DIC According to the rate of

18、 development, divide into 3 types Acute Subacute Chronicmalignant tumors collagenosismetastasis of malignanttumors; retained dead fetussevere infection or trauma ammiotic fluid embolism46 2. Types of DIC According to the rate of development, divide into 3 types Acute Subacute Chronicmild or conceale

19、dmicrothrombin formation bleeding shock, blooding exacerbate rapidly4748495051Back to cover next chapter52Summary53extensive hemorrhage at skin, mucosa and internal organsSummaryDisturbance of microcirculation (shock)Multiple organs dysfunction (MOD)Microangiopathic hemolytic anemia54Summary555565SH

20、OCKDIC?575SHOCKDIC?58 The function of coagulation system (Extrinsic, Intrinsic pathway and platelet) The function of anticoagulation (TFPI, PC system, ATIII and fibrinolytic system) The regulation of balance by VECThe key factors for balance of coagulation-anticoagulation:59returned bloodto hearteff

21、ective circulation blood volume peripheral resistanceheart function andcardiac output60MOD is usually the most important cause of death in DIC.61 Occurrence of MOD is related to following factors: (1) Extensive microthrombi formation in the organs ischemia, hypoxia, impairment of metabolism and function, or even necrosis and organ failure. (2) Pathologic alteration caused by effects of organs each other DIC Lungs pulmonary circulation Heart hypoxia, acidosis Other organs (3) Pathologic alteration and symptoms of primary diseases (which