Sarcomatous wilms tumor associated with consumption coagulopathy
Yoshihide OgawaSatoru IshikawaTsunetada YazakiShigeki TakahashiShohri KanoRyuichi KitagawaMasahiko TakahashiHisao KenmotsuHaruo OhkawaShigenori SawaguchiTakashi HanadaHitoshi TakitaKeijiro Yabuta
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Consumptive Coagulopathy
Coagulopathy in association with thrombotic complications and perhaps even disseminated intravascular coagulation (DIC) have become the hallmark of severe acute respiratory syndrome coronavirus 2 infections. The current guidance with regard to prevention of thrombosis and management of coagulopathy and DIC recommends pharmacological thromboprophylaxis be given to all immobilized and severely ill patients with COVID-19 unless otherwise contraindicated. Exploring the associated coagulation disease will aid in the understanding of the pathophysiological mechanisms underlying severe COVID-19.
2019-20 coronavirus outbreak
Pathophysiology
Coronavirus
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Coagulation testing
Abnormality
Exchange transfusion
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Our experience with consumptive coagulopathy associated with preeclampsia at North Carolina Baptist Hospital is presented. All cases of recognized consumptive coagulopathy on the obstetric service from 1969 to 1975 are reviewed and the associated obstetric entities given. Two cases of consumptive coagulopathy complicating severe preeclampsia are presented. Consumptive coagulopathy occurred in 9.1% of eclamptic patients and in 2.6% of severe preeclamptic patients. No previous incidence figures were found in the literature.
Consumptive Coagulopathy
Maternal morbidity
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Sepsis-induced disseminated intravascular coagulopathy is associated with a high mortality rate. The function and deformability of polymorphonuclear leukocytes change in patients with sepsis. The goal of this study was to characterize the changes in polymorphonuclear leukocyte deformability in patients with sepsis-induced disseminated intravascular coagulopathy and to evaluate the relationship between the severity of disseminated intravascular coagulopathy and the deformability of polymorphonuclear leukocytes.Thirty-five patients with sepsis-induced disseminated intravascular coagulopathy at our department were enrolled in this study. These patients were diagnosed with severe sepsis and an acute disseminated intravascular coagulopathy score ≥ 4. Blood samples were obtained from these patients on days 1, 3, and 7. Polymorphonuclear leukocyte deformability was measured with a microchannel flow analyzer, and polymorphonuclear leukocyte activity, represented as CD11b, was measured by flow cytometry. In contrast, 14 patients who fulfilled with sepsis criteria but without complicated disseminated intravascular coagulopathy were also entered in this study.In patients with sepsis-induced disseminated intravascular coagulopathy, there was a significant correlation between their Japanese Association for Acute Medicine disseminated intravascular coagulopathy score and polymorphonuclear leukocyte deformability, and CD11b expression. Polymorphonuclear leukocytes became more stiffened and CD11b expression was higher in patients with sepsis-induced disseminated intravascular coagulopathy compared to patients without the condition.Polymorphonuclear leukocyte deformability correlated with the severity of sepsis-induced disseminated intravascular coagulopathy and the response to treatment.
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Disseminated intravascular coagulation(DIC) remains a challenging syndrome for intensivists, as the markers enabling its identification are lacking, and the treatment is patient dependent.The process underlying DIC is a complex interlinked framework of proteases of both the coagulation and inflammatory cascades, thus explaining the difficulty in DIC management.Identification can be accomplished with scoring systems such as the DIC score, and treatment begins with identification and treatment of the underlying infectious cause.Supportive care and correction of coagulopathies should be provided simultaneously to prevent irreversible end-organ injury and DIC progression.
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Sepsis; Disseminated intravascular coagulation; Coagulopathy
Organ dysfunction
Identification
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Disseminated intravascular coagulation (DIC) represents a major challenge in obstetrics. The prognosis is influenced by the severity of the coagulopathy and its underlying condition. Early recognition of DIC, if possible, is important because of the potential for end-organ microvascular thrombosis and/or major blood loss. Obstetric DIC manifests mainly with bleeding. In order to facilitate the diagnosis and management of disseminated intravascular coagulation, a pregnancy-specific DIC score was developed. The therapy aims at treating the condition that triggers DIC, the hemorrhagic complications and the coagulopathy.
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Consumptive coagulopathy is a known complication of large vascular tumors. We describe 2 episodes of consumptive coagulopathy in young children, which were secondary to isolated splenic vascular tumors. One child was successfully treated by subtotal embolization of the spleen, whereas the second child required splenectomy after an initial embolization improved—but did not fully control—his consumptive coagulopathy.
Consumptive Coagulopathy
Kasabach–Merritt syndrome
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We present a case of disseminated intravascular coagulopathy developing rapidly after being bitten by a snake suspected to be Trimeresurus albolabris in a 67-year-old man. The unusually fast onset of coagulation disturbances and the later renal complication should alert emergency physicians that snakebites (including Trimeresurus albolabris) can be devastating if not managed promptly.
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Etiology
Pathophysiology
Clotting factor
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