《中山大学法律评论》.ppt

Infectious disease---the most common clinical condition associated with DIC; Severe trauma---acute DIC is often seen with serious injuries and burns caused by the release of thromboplastic material; Neoplasia---both solid tumor and cancer; Vascular disorder---large aortic aneurysms may result in local activation of coagulation; Obstetric accidents---includes amniotic fluidembolism and placental abruption, the fetus, the placenta, and the amniotic fluid are rich in thromboplastic substances. 1. Severe tissue injury Introduction into the circulation of substances with tissue thromboplastic activity may initiate the extrinsic clotting reactions. This can occur with severe trauma, wounds, major operation, malignant necrosis and by the actions of uterine contents in patients with obstetrical complications. 2. Extensive damage of vascular  endothelial cells Infection, shock , hypoxia and immune reactions can damage the vascular endothelial cells. Blood contacts with exposed collagen to trigger intrinsic clotting cascade through activation of factor Ⅻ and to aggregate platelets. In infection, gram-negative bacterial endotoxin can cause clotting in many animal species and endotoxinemia is a major cause of intravascular clotting. * * Disseminated Intravascular Coagulation (DIC) 【Change of basic pathology 】 Key change This fine homeostatic balance of controlled thrombin generation is lost in DIC. DIC represents a continuum in clinical – pathological severity, characterized by the increasing loss of localization or compensated control in intravascular activation of coagulation. It is characterized by the activation of the coagulation system with resultant consumption of a variety of coagulation proteins and platelets, which results in hemorrhagic diathesis and ischemic injury to various tissues. Concept Concept Prothrombotic state thrombotic state Low consumption of coagulation status Secondary fibrinolysis Basic path