Hematology and Oncology Book

Hemorrhage

Hypercoagulability

Miscellaneous

  • Disseminated Intravascular Coagulation

Cardiovascular Medicine Chapter related topics

Dermatology Chapter related topics

Examination Chapter related topics

Obstetrics Chapter related topics

Pathology and Laboratory Medicine Chapter related topics

Pharmacology Chapter related topics

Platelet Disorders Chapter related topics

Surgery Chapter related topics

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Disseminated Intravascular CoagulationAka: Disseminated Intravascular Coagulopathy, DIC

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  1. Causes
    1. Infection
      1. Gram Negative Sepsis
      2. Meningococcemia
      3. Rocky Mountain Spotted Fever
    2. Neoplastic disease
      1. Mucin-Secreting adenocarcinoma
      2. Promyelocytic Leukemia
      3. Prostate Cancer
      4. Lung Cancer
    3. Tissue Damage
      1. Trauma
      2. Surgery (e.g. Prostate Surgery)
      3. Heat Stroke
      4. Burn injury
      5. Dissecting aneurysm
    4. Obstetrical Complication
      1. Abruptio Placentae
      2. Amniotic Fluid Embolism
      3. Retained fetal products on intrauterine fetal death
      4. Severe Preeclampsia
      5. HELLP Syndrome
      6. Acute Fatty Liver of Pregnancy
    5. Hemolytic disease
      1. Thrombotic Thrombocytopenic Purpura (TTP)
      2. Hemolytic Uremic Syndrome (HUS)
    6. Immunologic Disorders
      1. Immune complex disorders
      2. Allograft rejection
      3. Incompatible blood transfusion
      4. Anaphylaxis
    7. Metabolic
      1. Diabetic Ketoacidosis
    8. Miscellaneous
      1. Shock
      2. Snake Bite
      3. Cyanotic Congenital Heart Disease
      4. Fat embolism
      5. Severe liver disease
      6. Cavernous Hemangioma
  2. Pathophysiology
    1. Intravascular fibrin deposition occludes small vessels
      1. Microemboli or thrombi form in vasculature
    2. Consumptive coagulopathy
      1. Widespread coagulation activation depletes factors
      2. Factors depleted
        1. Platelets
        2. Antithrombin III
        3. Protein C
        4. Tissue factor pathway inhibitor
  3. Signs and symptoms
    1. Profuse bleeding from many sites
      1. Needle puncture site bleeding
      2. Mucosal bleeding
      3. Surgical incision or Laceration bleeding
      4. Multiple bruises or Petechiae
    2. Thrombosis
      1. End organ ischemia or infarction
      2. Multi-system failure
    3. Associated conditions
      1. Acute Tubular Necrosis
      2. Adult Respiratory Distress Syndrome
      3. Purpura fulminans
  4. Labs: Initial
    1. Platelet Count <100,000/mm3
    2. Fibrinogen <300 mg/dl
    3. Fibrin split product >40 mg/dl
    4. Prothrombin Time (aPT) >14 seconds or INR increased
    5. Partial Thromboplastin Time >40 seconds
    6. D-Dimer
      1. Early indicator of DIC in Preeclampsia
      2. Trofatter (1989) Obstet Gynecol 73:435
  5. Labs: Monitoring (every 2 hours in DIC)
    1. Platelet Count
    2. Fibrinogen
  6. Management
    1. Supportive care
      1. ABC Management
      2. Cardiopulmonary support
    2. Treat underlying disorder
      1. Example: Delivery in pregnancy related DIC
      2. Example: Antibiotics in Sepsis
    3. Transfuse Blood Products as needed
      1. Packed Red Blood Cells
      2. Platelet transfusion for platelets <20,000 to 40,000
      3. Fresh frozen plasma (preferred over cryoprecipitate)
        1. Coagulation Factors
        2. Fibrinogen
    4. Heparin has been used in DIC (use is debated)
      1. Heparin continuous infusion at 300 to 500 IU/hour
  7. References
    1. Levi (1999) N Engl J Med 341:586

Dacarbazine (C0010927)

Definition (MSH)An antineoplastic agent. It has significant activity against melanomas. (from Martindale, The Extra Pharmacopoeia, 31st ed, p564)
Definition (CSP)cytotoxic alkylating agent used as an antineoplastic primarily for treatment of malignant melanoma and in combination chemotherapy for Hodgkin's disease and sarcomas; administered intravenously; abbreviated DTIC.
Definition (NCI)An anticancer drug that belongs to the family of drugs called alkylating agents.
Definition (PDQ)A triazene derivative with antineoplastic activity. Dacarbazine alkylates and cross-links DNA during all phases of the cell cycle, resulting in disruption of DNA function, cell cycle arrest, and apoptosis. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39768&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39768&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C411" NCI Thesaurus)
Definition (NCI)A triazene derivative with antineoplastic activity. Dacarbazine alkylates and cross-links DNA during all phases of the cell cycle, resulting in disruption of DNA function, cell cycle arrest, and apoptosis. (NCI04)
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishDacarbazina, Dacarbazine, DACARBAZINE PREPARATION, Dakarbazin, Decarbazine, DIC, Dimethyl Imidazole Carboxamide, Dimethyl Triazeno Imidazol Carboxamide, Dimethyl Triazeno Imidazole Carboxamide, dimethyltriazenoimidazole carboxamide, DTIC, ICDT, Imidazole Carboxamide Dimethyltriazeno
Spanishdacarbazina
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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