Sepsis-associated disseminated intravascular coagulation and its differential diagnoses

Journal of Intensive Care

Takeshi Wada¹  Shigeki Kushimoto²  Eizo Watanabe³  Hideo Wada⁴  Yutaka Umemura⁵  Toshiaki Iba⁶  Kei Hayashida⁷ 

[1] 0000 0001 2173 7691, grid.39158.36, Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan;0000 0001 2248 6943, grid.69566.3a, Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan;0000 0004 0370 1101, grid.136304.3, Department of General Medical Science Graduate School of Medicine Chiba University, Chiba, Japan;Department of Emergency and Critical Care Medicine Eastern Chiba Medical Center, Chiba, Japan;0000 0004 0372 555X, grid.260026.0, Department of Molecular and Laboratory Medicine, Mie University School of Medicine, Tsu, Japan;0000 0004 0373 3971, grid.136593.b, Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan;0000 0004 1762 2738, grid.258269.2, Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, 113-8421, Tokyo, Japan;0000 0004 1936 9959, grid.26091.3c, Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan;

关键词: Disseminated intravascular coagulation;    Sepsis;    Thrombotic thrombocytopenic purpura;    Hemolytic uremic syndrome;    Heparin-induced thrombocytopenia;   

DOI  :  10.1186/s40560-019-0387-z

来源: publisher

【 摘 要 】

Disseminated intravascular coagulation (DIC) is a common complication in sepsis. Since DIC not only promotes organ dysfunction but also is a strong prognostic factor, its diagnosis at the earliest possible timing is important. Thrombocytopenia is often present in patients with DIC but can also occur in a number of other critical conditions. Of note, many of the rare thrombocytopenic diseases require prompt diagnoses and specific treatments. To differentiate these diseases correctly, the phenotypic expressions must be considered and the different disease pathophysiologies must be understood. There are three major players in the background characteristics of thrombocytopenia: platelets, the coagulation system, and vascular endothelial cells. For example, the activation of coagulation is at the core of the pathogenesis of sepsis-associated DIC, while platelet aggregation is the essential mechanism in thrombotic thrombocytopenic purpura and endothelial damage is the hallmark of hemolytic uremic syndrome. Though each of the three players is important in all thrombocytopenic diseases, one of the three dominant players typically establishes the individual features of each disease. In this review, we introduce the pathogeneses, symptoms, diagnostic measures, and recent therapeutic advances for the major diseases that should be immediately differentiated from DIC in sepsis.

【 授权许可】

CC BY