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Disseminated intravascular coagulation

ISSN 2398-2993


Synonym(s): hypercoagulative disorders clotting cascade hemorrhages

Introduction

  • DIC and other hypercoagulative disorders are acquired conditions. They may be sequelae of other diseases that cause severe systemic inflammation.
  • Cause: severe systemic inflammation causing activation of the clotting cascade.
  • Signs: symptoms of the primary disease; thrombosis; hemorrhagic lesions.
  • Diagnosis: clinical signs of DIC, assessment of clotting parameters with laboratory tests.
  • Treatment: specific to the primary cause, aggressive IVFT, NSAIDs, anticoagulants.
  • Prognosis: guarded to very poor.

Presenting signs

Acute presentation

  • DIC will be secondary to another primary pathology.
  • The acute symptoms will be displaying alongside those caused by the underlying condition.

Geographic incidence

  • DIC can occur in cattle worldwide.

Age predisposition

  • Younger animals (especially those in septic shock) are at higher risk, but any age can be affected.

Breed/Species predisposition

  • Any breed of cattle might be at risk.

Public health considerations

  • Only in the case of primary infections caused by zoonotic pathogens.

Cost considerations

  • The prognosis for a patient, once in DIC is extremely poor.
  • Treatment of DIC requires intensive care and hospitalization. The cost of this is often higher than the value of the animal.
  • Veterinary care in the field may prove ineffective and animal welfare may be compromised.
  • Monetary loss of the individual animal’s value.
  • Cost of replacements.

Special risks

  • Hypotension is a risk during DIC therefore anesthetics are not recommended.
  • These animals are also often severely dehydrated.

Pathogenesis

Etiology

  • DIC is a hemorrhagic diathesis resulting from a variety of injuries to the clotting pathways:
    • Extensive platelet activation, causing aggregation and blockage within the smaller diameter blood vessels.
    • Liver conditions, causing deficit in the clearance of activated factors and general blood proteins metabolism.
    • Activation of the intrinsic or extrinsic pathways; this may be a result of endothelial damage and/or collagen exposure in diseases that cause vasculitis.
    • Tissue necrosis: animals suffering from black leg Clostridial myositis or other clostridial diseases are at risk.

Pathophysiology

  • DIC is a hemorrhagic diathesis; its main characteristics are:
    • Increased activity of normal clotting mechanisms.
    • Depletion of coagulation factors.
    • Formation of fibrin clots within the vasculature.
    • Secondary activation of fibrinolytic processes.
  • Primary condition causes systemic inflammation (Systemic Inflammatory Response Syndrome SIRS).
  • Activation of cytokine cascade, in particular Interleukin (IL)-1, IL-6, IL-8 and TNF-α.
  • Complement activation may be present.
  • Clotting is initiated by the intrinsic or extrinsic pathways.
  • Increase in thrombin.
  • Decreases in plasma antithrombin, plasminogen and protein C.
  • Increased fibrin synthesis and decreased fibrinolysis.

Timecourse

  • Extremely fast course once the clotting cascade has started.

Epidemiology

  • This is relatively rare condition in cattle; mostly individuals are affected rather than large groups.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Bell C (2011) Bleeding disorders in cattle. In Pract 33 (3), 106-115 VetMedResource.
  • Irmak K & Turguk K (2005) Disseminated Intravascular Coagulation in cattle with abomasal displacement. Vet Res Commun 29 (1),  61-68  PubMed.
  • Wellde B T, Chumo D A, Onyango F K et al  (1989)  Trypanosoma vivax:  disseminated intravascular coagulation in cattle.  Annals Tropical Med & Parasitol83 (Suppl 1), 177-183 PubMed.
  • Momotani E, Yabuki Y, Miho H et al (1985) Histopathological evaluation of disseminated intravascular coagulation in Haemophilus somnus infection in cattle. J Comp Pathol 95 (1), 15-23 PubMed.

Other sources of information

  • Bain F T, Dawson S, Knottenbelt D & Morgan R (online) Disseminated Intravascular Coagulation. In: Vetlexicon Equis. Vetstream Ltd, UK. Website: www.vetlexicon.com.
  • Radostits O M, Gay C C, Hinchcliff K W & Constable P D (2007) Veterinary Medicine – A Textbook of the Diseases of Cattle, Horses, Sheep, Pigs and Goats. 10th edn. Elsevier, USA.