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DIC - disseminated intravascular coagulation.TTP - thrombotic thrombocytopenic purpura
1.
DIC- DISSEMINATED INTRAVASCULARCOAGULATION
TTP- THROMBOTIC
PURPURA
THROMBOCYTOPENIC
Dr Tzoran Inna
Thrombosis and Hemostasis Unit
Rambam Medical Center
2.
DICDISSEMINATEDINTRAVASCULAR
COAGULATION
3.
Widespread coagulation activationUnregulated consumption of thrombocytes ad
coagulation factors
Bleeding or thrombosis
4.
5.
Bleeding is most frequentBleeding of skin and gastrointestinal tract
Thrombosis frequently associated with
malignancy
6.
DIC - REASONSSepsis
Gynecological catastrophe – abruptio placenta,
amniotic fluid emboli
Malignancy-APL
Multiple trauma
Burns
Hypertermia
Snake bite
7.
8.
CHRONIC DICSlow, sub-clinical course
Malignancy- prostata, pancrease
Intrauterine death
Aortic aneurism
Large hemangioma
9.
DIC- LABORATORY TESTSProlonged PT, PTT
Low fibrinogen
Low thrombocytes
High D-Dimers
10.
PLTPT
PTT
RBC
Fragments
DIC
Low
Prolonged
Prolonged
+
Liver
Cirrhosis
Low
Prolonged
Prolonged
±
Massive
Bleeding
Low
Prolonged
Prolonged
±
TTP
Low
Normal
Normal
+++
11.
DIC - TREATMENTTreatment 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 THROMBOCYTOPENICPURPURA
von Willebrand factor (vWF) cleaving protease
ADAMTS 13 deficiency
Accumulation of large multimers of VWF
13.
14.
TTPClinical Syndrome
Thrombocytopenia
Hemolytic anemia
High LDH
Neurological symptoms
RBC fragments
15.
Inherited lack of ADAMTS13Acquired antibodies to ADAMTS 13
- Gram neg bacteremia
- Pregnancy
- Drugs
- HIV
- Malignancy
- Organ or BM transplantation
16.
TTP- TREATMENTPlasmapheresis with plasma or albumin
Rithuximab
Avoid thrombocytes infusion