Mechanism of pathology 病理机制 The release of procoagulation factors 促凝因子的释放：TF The emission of chemical mediator 化学介质的释放：TNF-aIL-1,PAI-1 。 Exhausting anti-coagulation factors 消耗抗凝物质：PC\AT\TM\PS\TFPI Activation of fibrinolysis 纤溶激活：t-PA
Mechanism of pathology 病理机制 • The release of procoagulation factors 促凝因子的释放：TF • The emission of chemical mediator 化学介质的释放：TNF-α\IL-1，PAI-1 • Exhausting anti-coagulation factors 消耗抗凝物质：PC\AT\TM\PS\TFPI • Activation of fibrinolysis 纤溶激活：t-PA
Manifestations I临床表现 ·Bleeding climate出血倾向 ·Refractory shock顽固性休克 ·Microcirculation failure微循环衰竭 anoxia,out of breath,disturbance of consciousness,intracranial hypertention,oliguria 缺氧，呼吸困难，意识障碍，颅内高压，少尿 Fragmentation-type hemolysis 微血管病性溶血 Manifestations of underlying diseases基a础病表 现
Manifestations 临床表现 • Bleeding climate 出血倾向 • Refractory shock 顽固性休克 • Microcirculation failure 微循环衰竭 anoxia, out of breath, disturbance of consciousness, intracranial hypertention, oliguria 缺氧，呼吸困难，意识障碍，颅内高压，少尿 • Fragmentation-type hemolysis 微血管病性溶血 • Manifestations of underlying diseases 基础病表 现
Diagnosis诊断 Existence of underlying diseases?存在基础病 manifestations:multiple signs of bleeding, hypoperfusion signs,effectiveness of anticoagulation.表现为多发性出血，微灌注 不足，抗凝治疗有效
Diagnosis 诊断 • Existence of underlying diseases存在基础病 • manifestations: multiple signs of bleeding, hypoperfusion signs, effectiveness of anticoagulation. 表现为多发性出血，微灌注 不足，抗凝治疗有效
Diagnosis Coagulation laboratory tests:decreased platelets <100,000/ul or <50,000/ul,lowered or elevated fibrinogen <1.5g/L or >4g/L, increased fibrinolytic parameters FDP>20mg/L or DD>20mg/L,prolonged PT 3'higher than normal 。 实验室检查包括：血小板减少，纤维蛋白 原降低或增高，纤溶指标增高，PT延长
Diagnosis • Coagulation laboratory tests: decreased platelets <100,000/ul or <50,000/ul, lowered or elevated fibrinogen <1.5g/L or >4g/L, increased fibrinolytic parameters FDP>20mg/L or DD>20mg/L, prolonged PT 3’ higher than normal • 实验室检查包括：血小板减少，纤维蛋白 原降低或增高，纤溶指标增高，PT延长
诊断的积分标准 依据是否伴有DIC相关的疾病，如伴有就进入显性D1C的1STH积分标准 0分 1分 2分 3分 血小板数量 >100×10^9/ 50~100×109/L <50×10^9/① L pT延长 <3s 3~6s >6s 纤溶指标 不升高 中度升高 明显升高 纤维蛋白原 >1g/L <1g/L 累计分数达到5分及以上就诊断为显性DIC,否则为非显性DIC,1~2天后再 次积分
诊断的积分标准 依据是否伴有DIC相关的疾病，如伴有就进入显性DIC的ISTH积分标准