Acute generalized, widespread bleeding. Diagnosis and management

Background and Objective. Acute generalized, widespread bleeding is often r elated to disseminated intravascular coagulation (DIC), a pathologic proces s which complicates the clinical course of many diseases and is characteriz ed by huge amounts of thrombin and plasmin within the circulation. The fina l result is the consumption of platelets, coagulation factors and inhibitor s, as well as secondary hyperfibrinolysis, all leading to diffuse hemorrhag e and microthromboses. This review article examines the present attitudes t o the diagnosis and treatment of overt DIC in clinical practice, emphasizin g the importance of an accurate differential diagnosis from some other proc esses characterized by acute generalized, widespread bleeding. Information Sources. The authors have been working in this field, both at e xperimental and clinical levels, contributing original papers for many year s. In addition, material examined in this review includes articles publishe d In journals covered by MedLine(R), recent reviews in journals with high I mpact factor and in relevant books on hemostasis and thrombosis. State of Art and Perspectives. DIC is an intermediary mechanism of disease which complicates the clinical course of many well-known disorders. Althoug h the systemic hemorrhagic syndrome Is the predominant clinical manifestati on, massive intravascular thrombosis frequently occurs contributing to isch emia and associated organ damage, making the mortality rate of this conditi on high. Current concepts on the pathophysiology, laboratory diagnosis and management of DIC are presented. Complex pathophysiological interrelations make the diagnosis of the etiology of the DIC difficult in clinical practic e, although simple tests are useful for identification of patients with the process. Laboratory diagnosis of DIC is mainly based on screening assays, which allow a rapid diagnosis, whereas some other highly sensitive but more complex assays are not always available to routine clinical laboratories. The management of DIC is based on the treatment of the underlying disease, supportive and replacement therapies and the control of the coagulation mec hanisms. Although some advances have been achieved, management decisions ar e still controversial, so that therapy should be highly Individualized depe nding on the nature of the DIC and severity of clinical symptoms. Many synd romes sharing common findings with DIC, such as primary hyperfibrinolysis o r thrombotic thrombocytopenic purpura, should be excluded. Finally, new the rapeutic approaches to the management of this potentially catastrophic synd rome are required. (C)1998, Ferrata Storti Foundation.