Consumption Coagulopathy Follow-up

  • Author: Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: Oct 26, 2011
 

Further Inpatient Care

Because most children with disseminated intravascular coagulation (DIC) are critically ill, serial monitoring of laboratory values is necessary. CBC count, prothrombin time (PT) and activated partial thromboplastin time (aPTT), D-dimers, and fibrinogen measurements should be frequently repeated.

Organ involvement and concurrent illness dictate the need for additional laboratory studies.

Next

Further Outpatient Care

Follow-up care with subspecialists may be required depending on the patient's underlying disorder and clinical course.

Previous
Next

Inpatient & Outpatient Medications

The patient's underlying disorder and clinical course dictate the medications required at discharge.

Patients with chronic DIC may benefit from treatment with low molecular weight heparin (LMWH) on an outpatient basis. Recommended dosages are 1-1.5 mg/kg given subcutaneously every 12 hours.

Previous
Next

Transfer

Transfer pediatric patients to tertiary care centers with a pediatric ICU and subspecialists.

Previous
 
Contributor Information and Disclosures
Author

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP  Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sills, MD  Professor of Pediatrics, Upstate Medical University

Richard H Sills, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary R Jones, MD  Associate Medical Director, Clinical Development, Berlex Laboratories

Gary R Jones, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Gary D Crouch, MD  Associate Professor, Program Director of Pediatric Hematology-Oncology Fellowship, Department of Pediatrics, Uniformed Services University of the Health Sciences

Gary D Crouch, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Samuel Gross, MD  Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Paul J Galardy, MD, Eric Grabowski, MD, ScD, and Jennifer Boden Cerone, MD, to the development and writing of this article.

References

  1. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. Aug 19 1999;341(8):586-92. [Medline].

  2. Shimura M, Wada H, Wakita Y, et al. Plasma tissue factor and tissue factor pathway inhibitor levels in patients with disseminated intravascular coagulation. Am J Hematol. Aug 1997;55(4):169-74. [Medline].

  3. Nieuwland R, Berckmans RJ, McGregor S, Boing AN, Romijn FP, Westendorp RG. Cellular origin and procoagulant properties of microparticles in meningococcal sepsis. Blood. Feb 1 2000;95(3):930-5. [Medline].

  4. Morel N, Morel O, Petit L, et al. Generation of procoagulant microparticles in cerebrospinal fluid and peripheral blood after traumatic brain injury. J Trauma. Mar 2008;64(3):698-704. [Medline].

  5. Langer F, Spath B, Haubold K, Holstein K, Marx G, Wierecky J. Tissue factor procoagulant activity of plasma microparticles in patients with cancer-associated disseminated intravascular coagulation. Ann Hematol. Jun 2008;87(6):451-7. [Medline].

  6. Arbuthnot C, Wilde JT. Haemostatic problems in acute promyelocytic leukaemia. Blood Rev. Jun 3 2006;[Medline].

  7. Asakura H, Ontachi Y, Mizutani T, et al. Elevated levels of free tissue factor pathway inhibitor antigen in cases of disseminated intravascular coagulation caused by various underlying diseases. Blood Coagul Fibrinolysis. Jan 2001;12(1):1-8. [Medline].

  8. Grewal PK, Uchiyama S, Ditto D, Varki N, Le DT, Nizet V. The Ashwell receptor mitigates the lethal coagulopathy of sepsis. Nat Med. Jun 2008;14(6):648-55. [Medline].

  9. Oren H, Cingoz I, Duman M. Disseminated intravascular coagulation in pediatric patients: clinical and laboratory features and prognostic factors influencing the survival. Pediatr Hematol Oncol. Dec 2005;22(8):679-88. [Medline].

  10. Wada H. Disseminated intravascular coagulation. Clin Chim Acta. Jun 2004;344(1-2):13-21. [Medline].

  11. Levi M, de Jonge E, Meijers J. The diagnosis of disseminated intravascular coagulation. Blood Rev. Dec 2002;16(4):217-23. [Medline].

  12. Taylor FB, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. Nov 2001;86(5):1327-30. [Medline].

  13. Dempfle CE, Wurst M, Smolinski M, et al. Use of soluble fibrin antigen instead of D-dimer as fibrin-related marker may enhance the prognostic power of the ISTH overt DIC score. Thromb Haemost. Apr 2004;91(4):812-8. [Medline].

  14. Voves C, Wuillemin WA, Zeerleder S. International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients. Blood Coagul Fibrinolysis. Sep 2006;17(6):445-51. [Medline].

  15. Ettingshausen CE, Veldmann A, Beeg T, Schneider W, Jäger G, Kreuz W. Replacement therapy with protein C concentrate in infants and adolescents with meningococcal sepsis and purpura fulminans. Semin Thromb Hemost. 1999;25(6):537-41. [Medline].

  16. White B, Livingstone W, Murphy C, Hodgson A, Rafferty M, Smith OP. An open-label study of the role of adjuvant hemostatic support with protein C replacement therapy in purpura fulminans-associated meningococcemia. Blood. Dec 1 2000;96(12):3719-24. [Medline].

  17. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. Mar 8 2001;344(10):699-709. [Medline].

  18. Schellongowski P, Bauer E, Holzinger U, Staudinger T, Frass M, Laczika K. Treatment of adult patients with sepsis-induced coagulopathy and purpura fulminans using a plasma-derived protein C concentrate (Ceprotin). Vox Sang. May 2006;90(4):294-301. [Medline].

  19. Yilmaz D, Karapinar B, Balkan C, Akisu M, Kavakli K. Single-center experience: use of recombinant factor VIIa for acute life-threatening bleeding in children without congenital hemorrhagic disorder. Pediatr Hematol Oncol. Jun 2008;25(4):301-11. [Medline].

  20. Fischer D, Schloesser R, Buxmann H, Veldman A. Recombinant activated Factor VII as a hemostatic agent in very low birth weight preterms with gastrointestinal hemorrhage and disseminated intravascular coagulation. J Pediatr Hematol Oncol. May 2008;30(5):337-42. [Medline].

  21. Nadel S, Goldstein B, Williams MD, et al. Drotrecogin alfa (activated) in children with severe sepsis: a multicentre phase III randomised controlled trial. Lancet. Mar 10 2007;369(9564):836-43. [Medline].

  22. Marti-Carvajal AJ, Comunian-Carrasco G, Pena-Marti GE. Haematological interventions for treating disseminated intravascular coagulation during pregnancy and postpartum. Cochrane Database Syst Rev. Mar 16 2011;3:CD008577. [Medline].

  23. Baratto F, Michielan F, Meroni M, Dal Palu A, Boscolo A, Ori C. Protein C concentrate to restore physiological values in adult septic patients. Intensive Care Med. Sep 2008;34(9):1707-12. [Medline].

  24. Bick RL. Disseminated intravascular coagulation: objective clinical and laboratory diagnosis, treatment, and assessment of therapeutic response. Semin Thromb Hemost. 1996;22(1):69-88. [Medline].

  25. de Jonge E, Dekkers PE, Creasey AA, et al. Tissue factor pathway inhibitor dose-dependently inhibits coagulation activation without influencing the fibrinolytic and cytokine response during human endotoxemia. Blood. Feb 15 2000;95(4):1124-9. [Medline].

  26. Hazelzet JA, Risseeuw-Appel IM, Kornelisse RF, et al. Age-related differences in outcome and severity of DIC in children with septic shock and purpura. Thromb Haemost. Dec 1996;76(6):932-8. [Medline].

  27. Levi M. Disseminated intravascular coagulation: What's new?. Crit Care Clin. Jul 2005;21(3):449-67. [Medline].

  28. Sakuragawa N, Hasegawa H, Maki M, et al. Clinical evaluation of low-molecular-weight heparin (FR-860) on disseminated intravascular coagulation (DIC)--a multicenter co- operative double-blind trial in comparison with heparin. Thromb Res. Dec 15 1993;72(6):475-500. [Medline].

  29. Sallah S, Husain A, Nguyen NP. Recombinant activated factor VII in patients with cancer and hemorrhagic disseminated intravascular coagulation. Blood Coagul Fibrinolysis. Oct 2004;15(7):577-82. [Medline].

  30. Wang ZY, Chen Z. Acute promyelocytic leukemia: from highly fatal to highly curable. Blood. Mar 1 2008;111(5):2505-15. [Medline].

 
Previous
Next
 
Purpura fulminans.
Peripheral blood of a child with disseminated intravascular coagulation demonstrates thrombocytopenia and many schistocytes (Wright stain, original magnification X 1000).
Table. DIC Scoring System
MeasureScore
0123
Platelet count>100 X 109/L< 100 X 109/L< 50 X 109/LNA
PT prolongation, s0-33-66NA
Fibrinogen level (mg/dL)>100< 100NANA
Fibrin split productsNANA++++
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.