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Chronic DIC: Laboratory abnormalities
Hypofibrinogenemia ( or relative decrease in fibrinogen)
Thrombocytopenia (or relative decrease in PLT count)
Fibrinogen-fibring degradation products
Increased PT
Increased PTT
Decreased factors V, VIII, X
Poor in-vitro clot formation
Microangiopathic hemolytic anemia (occurs in ~50%)
Cryoprotein(s)
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Clinical Manifestations:
1. Thrombophlebitis
2. NBTE (Tricuspid/mitral valves)
3. Hemorhagic phenomena
4. Arterial thrombi
5. PE
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TREATMENT
IN APL:
1. Distinguish DIC from primary fibrinolysis
Use Amicar if it is primary fibrinolysis
Use heparin (low dose CI) if DIC.
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How Does It Happen?
1. Tumor cells release specific protease enzymes that can cleave & therefore activate clotting factors (i.e. Cytein protease activating Factor X)
2. Tumor cells release tissue factor
3. Tumor cells activate platelets
4. tumor:PLT aggregates can occur (vis vWF)
5. vWF interacts with laminin, tumors, & PLTS
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Coagulopathy associated with chemotherapy agents:
TTP/microangiopathic process:
mitomycin C
Cavernous Sinus Thrombosis:
L-Asparaginase
MI:
Cisplatin
Bleomycin
Veno-occlusive Disease:
Bleomycin
Mitomycin
Busulfan (POD)
High-dose Ara-C (HOD)
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