DIC协和.ppt

DIC协和
轴
Thrombin Explosion under Pathological Conditions
IXa
(+VIII)
Xa
(+V)
TF+VIIa
Thr GMP-140。
2. 血浆Fibrinogen含量<。
3. 3P阳性或血浆FDP>20mg/L或D-Dimer水平升高。
4. PT缩短或延长3s以上或呈动态变化。
5. Plasminogen含量及活性降低。
附：肝病合并DIC的实验室标准
1. 血小板<50109/L或有2项以上血浆血小板活化产物升高: -TG； PF4； TXB2； GMP-140。
2. 血浆Fibrinogen含量<。
3. 血浆FVIII:C活性<50%。
4. PT延长5s以上或呈动态变化。
5. 3P阳性或血浆FDP>60mg/L或D-Dimer水平升高。
慢性DIC
在转移癌、肝病、、SLE、巨大血管瘤或死胎滞留综合征等情况下，慢性持续或间歇性启动血管内凝血引发的DIC。栓塞较出血常见。
实验室：
血小板数轻度减少。
Fibrinogen正常或升高。
PT、APTT可能正常。
FDPs、D-Dimer升高。
破碎RBC常见、但程度逊于TTP者。
Diagnostic algorithm for overt DIC - ASH 2002
1. Risk assessment: Does the patient have a underlying disorder known to
be associated with overt DIC?
If yes, proceed. If no, do not use this algorithm.
2. Order global coagulation tests (platelet count, prothrombin time [PT],
fibrinogen, soluble fibrin monomers, or fibrin degradation products).
3. Score global coagulation test results:
platelet count -------------------------------------------------------------------- 
(> 100 = 0, < 100 = 1, < 50 = 2)
elevated fibrin-related marker (., soluble fibrin ---------------------- 
monomers/fibrin degradation products)
(no increase = 0, moderate increase = 2, strong increase = 3)
prolonged prothrombin time -------------------------------------------------- 
(< 3 sec. = 0, > 3 but < 6 sec. = 1, > 6 sec. = 2)
fibrinogen level ------------------------------------------------------------------- 
(> g/L = 0, < g/L = 1)
4. Calculate score. -------------------------------------------------------------------- 
5. If ≥5: compatible with overt DIC; repeat scoring daily.
If < 5: suggestive (not affirmative) for non-overt DIC; repeat next 1-2 days.
3P (Plasma Protamine Paracoagulation) Test
Fg
FM (Fibrin Monomer)
FDP
Thrombin
肽A、B
FM + FDP
SPMC (Soluble Protein Monomer Complex)
鱼浆蛋白
FDP
FM游离出来并
聚集成纤维状、
絮状或胶冻状
Plasmin
ELT (Euglobulin