DIC/Coagulation Problems

Question 1

What are triggers of DIC in pregnancy?

Answer 1

Retention of dead fetus (of > 20 weeks gestation which has been dead for >3 weeks)
Pre-eclampsia
Placental abruption
Endotoxic shock
Amniotic fluid embolism
Placenta accreta
Hydatidiform mole
Prolonged shock from any cause
Acute fatty liver of pregnancy

Question 2

What happens in DIC in pregnancy?

Answer 2

Thromboplastin are released into the circulation, fibrin and platelets are consumed as intra-vascular clotting occurs

Question 3

What tests for DIC?

Answer 3

Kaolin-cephalin clotting time increases (reduced factors II, V, VII)
Reduced fibrinogen
Increased fibrin degeneration products

Cross match blood
Platelets
Partial thromboplastin time
Prothrombin time

Question 4

What management for DIC

Answer 4

Presentation may be as heavy bleeding and shock - correct shock
O2 at 15L/min via non-rebreathe
2 14G IVI
Take bloods
Give blood
Give FFP

Calcium is sometimes needed to counteract citrate in stored blood- 10ml of 10% calcium glunate