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Disseminated intravascular coagulation
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
- Presence of a predisposing cause, such as:
- Toxic mastitis Mastitis: approach to the cow with acute mastitis.
- Septic metritis Uterine infection: overview.
- Septicemia SIRS
- Enteritis.
- Endotoxemia
- Displaced abomasum, especially RDA Right displaced abomasum: surgical technique.
- Gastrointestinal catastrophe, such as volvulus or intussusception
.
- Infection with Histophilus somnus Histophilus somni infection.
- Infection with Trypanosoma vivax Trypanosomiasis.
- Jugular vein thrombosis (usually following IV injections); in cows this might also affect other large venous vessels such as the milk veins Thrombophlebitis.
- Symptoms of ischemic damage to organs such as kidneys or GI tract
.
- Hemorrhages and/or hemorrhagic lesions:
- Petechiae
.
- Hematomas Hematoma.
- Epistaxis.
- Melena Abomasal ulceration
.
- Petechiae
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 & Parasitol 83 (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.