Cid 03.11.2022

Coagulación Intravascular Diseminada
Presentan:
Dra. Maria del Carmen Valles Hernández R2MI
Dr. Juan Fernando Barrón Momox R3MI
Coordina:
Dr. Luis Alberto Guizar García MBMI
CONTENIDO
1. INTRODUCCIÓN
2. CAUSAS
3. FISIOPATOLOGÍA
4. PRESENTACIÓN CLÍNICA
5. DIAGNÓSTICO
6. DIFERENCIALES
7. MANEJO
HISTORIA
• One of the first reports comes from M. Dupuy in

1834, who describes the effect of the intravenous in-
jection of brain material in animals.
• The animals almost immediately died and at autopsy
there were widespread clots in the circulation, pre-
sumably due to what we would now call tissue fac-
tor-dependent systemic activation of coagulation.
Dupuy M. Injections de matière cérébrale dans les veines. Gaz Med Paris, 1834;2:524
HISTORIA
• After 30 years, Trousseau described
• the thrombotic tendency and the inclination of blood to
• clot in patients with advanced malignant disease
Trousseau A. Phlegmasia alba dolens. Clin Med Hotel Dieu Paris

1865;3:695
• HISTORIA
In 1873,
• Naunyn showed that disseminated thrombosis could be
• evoked by intravenous injection of dissolved red cells, and
• Wooldridge demonstrated that the procoagulant involved
• was a substance contained in the stroma of the red cells.
Naunyn B. I. Untersuchungen über Blutgerinnung im lebenden

Thiere und ihre Folgen. Arch Exp Pathol Pharmacol 1873;3(1):1–17
Wooldridge LC. Note on the relation of the red cell corpuscules to
coagulation. Practitioner 1886;(38):187
Wooldridge LC. Ueber intravasculare gerinnungen. Arch Ant Physiol
Abt (Leipzig) 1886:397
HISTORIA
• A more precise description of DIC and its underlying
• pathogenesis had to wait until 1955 when more insight
• into the mechanism of blood coagulation was attained and
• better laboratory tests had become available. Ratnoff et al
• carefully described the hemostatic abnormalities that occur
• inwomenwith fetal death and amniotic fluid embolism.6
HISTORIA
• The mechanism by which DIC can lead to bleeding was clarified
• only in 1961, when Lasch et al introduced the concept of
• consumption coagulopathy.
• In 1965 McKay, who was to the

• first to realize that DIC was an “intermediary mechanism” in
• many diseases, published the first book on the DIC.
Lasch HG, Heene DL, Huth K, Sandritter W. Pathophysiology,

clinical manifestations and therapy of consumption-coagulopathy
(“Verbrauchskoagulopathie”). Am J Cardiol 1967;20(3):
381–391
McKay DG. Disseminated Intravascular Coagulation: An Intermediary

Mechanism of Disease. New York, NY: Hoeber Medical
DEFINICION
• In 2001, the International Society on Thrombosis and Hemostasis
(ISTH) proposed a definition of DIC that included microvascular
thrombosis: “DIC is an acquired syndrome characterized by the in-
travascular activation of coagulation without a specific localization
and arising from different causes. It can originate from and cause
damage to the microvasculature, which if sufficiently severe, can
produce organ dysfunction.”
Taylor FB Jr, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system
for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327-1330.
It should be stressed that DIC is not an independent clini-
cal condition
but is always a complication of another disease that re-
sults in
the activation of coagulation.
Levi M, Scully M. How I treat disseminated intravascular coagulation.

Blood. 2018;131:845‐854.
Epidemiología
Etiología
Fisiología de la coagulación
Fisiopatología
Excess thrombin generation in disseminated intravascular coagulation leads to bleeding and/or thrombosis depending on the
dominant change affecting the dynamic balance in both coagulant and fibrinolytic consequences
Criterios diagnósticos
DIAGNÓSTICOS DIFERENCIALES
PATOLOGÍAS QUE CURSAN CON PROLONGACIÓN DE TIEMPO DE COAGULACIÓN
• CIRROSIS HEPÁTICA
• HELLP
• TROMBOFILIAS
• DEFICIENCIA DE VITAMINA K
PATOLOGÍAS QUE CURSAN CON TROMBOCITOPENIA

• CIRROSIS HEPÁTICA
• SÍNDROME HEMOLÍTICO-URÉMICO
• PÚRPURA TROMBOCITOPÉNICA TROMBÓTICA
• TROMBOCITOPENIA INDUCIDA POR HEPARINA
• TROMBOCITOPENIA DEL EMBARAZO
• TROMBOCITOPENIA INMUNE PRIMARIA
• APLASIA MEDULAR
CID VS PTT VS SHU
• LA PRESENCIA DE TROMBOCITOPENIA SUELE SER MÁS ACENTUADA EN PTT Y SHU

• SE ACOMPAÑAN DE HEMÓLISIS INTRAVASCULAR, CON ELEVACIÓN DE DHL
• EN EL FSP ES FRECUENTE ENCONTRAR ESQUISTOCITOS, RELACIONADOS CON LA MICROANGIOPATÍA
TROMBÓTICA.
• LOS TIEMPOS DE COAGULACIÓN SUFREN POCA ALTERACIÓN O MÍNIMA EN COMPARACIÓN CON CID.
CID VS HIT VS PTI VS TIE
• LA TROMBOCITOPENIA TIENE RELACIÓN TEMPORAL CON EL USO DE HEPARINAS

• GENERALMENTE NO HAY ALTERACIÓN EN LOS TIEMPOS DE COAGULACIÓN
• EL USO DEL 4T SCORE AYUDA PARA CONFIRMAR O DESCARTAR LA CAUSA
• EN EL CASO DE PTI Y TIE, LA ÚNICA ALTERACIÓN ENCONTRADA ES TROMBOCITOPENIA
CID VS CIRROSIS HEPÁTICA
• EN PACIENTES CON ENFERMEDAD AGUDA, RESULTA DIFÍCIL DISCERNIR ENTRE AMBAS CAUSAS, RE-
SULTA ÚTIL EL CONTAR CON EL ANTECEDENTE DE LA ENFERMEDAD Y TOMAR EN CONSIDERACIÓN EL
NIVEL BASAL DE PLAQUETAS Y DIMERO D, ASÍ COMO LOS CAMBIOS EN EL CONTEO DE CADA UNO,
ADEMÁS DE OTRAS ALTERACIONES BIOQUÍMICAS, RELACIONADAS CON DISFUNCIÓN HEPÁTICA,
COMO AST/ALT, BILIRRUBINAS.
MANEJO
LO TRANSFUNDO??
• LA TRANSFUSIÓN DE HEMODERIVADOS SOLO ESTÁ INDICADA EN AQUELLOS PACIENTES CON DESCEN-
SO IMPORTANTE DE HEMOGLOBINA O EN EL CASO DE PLAQUETAS <20MIL O <50MIL SI SE PLANTEA
UN PROCEDIMIENTO INVASIVO.
• EL USO DE CRIOPRECIPITADOS SOLO SE RECOMIENDA EN CASO DE FIBRINOGENO <150
SE ANTICOAGULA??
• SE RECOMIENDA EL USO DE TROMBOPROFILAXIS CON HBPM EN CASO DE DATOS DE DISFUNCIÓN
ORGÁNICA, CON O SIN DATOS DE HEMORRAGIA MENOR.
• SE RECOMIENDA EL USO DE ANTICOAGULACIÓN CON HBPM SOLO EN AQUELLOS PACIENTES CON EVI-
DENCIA FRANCA DE UN SITIO DE TROMBOSIS.
Y LA CAUSA??
• EL MANEJO DEFINITIVO DE LA CID ES EL TRATAMIENTO DE LA CAUSA DESENCADENANTE.
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Coagulación Intravascular Diseminada

• One of the first reports comes from M. Dupuy in

Trousseau A. Phlegmasia alba dolens. Clin Med Hotel Dieu Paris

Naunyn B. I. Untersuchungen über Blutgerinnung im lebenden

• In 1965 McKay, who was to the

Lasch HG, Heene DL, Huth K, Sandritter W. Pathophysiology,

McKay DG. Disseminated Intravascular Coagulation: An Intermediary

Levi M, Scully M. How I treat disseminated intravascular coagulation.

PATOLOGÍAS QUE CURSAN CON TROMBOCITOPENIA

• LA PRESENCIA DE TROMBOCITOPENIA SUELE SER MÁS ACENTUADA EN PTT Y SHU

• LA TROMBOCITOPENIA TIENE RELACIÓN TEMPORAL CON EL USO DE HEPARINAS

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