Diagnosis and treating _'s treatment of blood coagulation in liver hard compound and disseminated blood vessel

Diagnosis and treating _'s treatment of blood coagulation in liver hard compound and disseminated blood vessel
Wu JianXin Hu Ying Shen ZhongMei Zhang Qiong Meng XiangJun Li Dingguo Lu HanMing 2005-12-13 13:49:55 Practise the magazine in Chinese medical science Number 8 of Vol. 2 of August of 2003
[Summary ] Purpose Diagnose liver cirrhosis erupts blood coagulation (DIC) in the disseminated blood vessel simultaneously in time and accurately It is more difficult. I study the characteristic change about appearing, blood coagulation index in this pathologic course, it is discussed how to diagnose and treat this serious hepatopathy complication rationally. Method liver hard compound and patient that the lung infected, present the inclination of bleeding, is shown as the large stretch of skin plays the silt spot. Measure the DIC relevant happening, blood coagulation index such as blood platelet to count (PLT) , thrombinogen time (PT) , fibrinogen (Fg) , fibrin ( Original) Degrade products (FDP) , 3P test, activate some the intersection of blood coagulation and living the intersection of enzyme and time (APTT) , thrombese time (TT) , F: C, F: C/vWF: Ag, D - gather the body (D-D) two times And excellent globulin is dissolved and tested (ELT) ,And observe the dynamic changes of these indexes continuously. Finally in the condition was developed, the patient's PLT, Fg were reduced; PT, APTT, TT,etc. lengthen; F : C reduces, F: C/vWF: Ag reduces more obviously; D-D increases notably. The patient accepts Heparin is anticoagulatory after treating, bleed and incline to take a favorable turn, but liver function worsens. Conclusion the intersection of person who is infect and inducement can cause the liver cirrhosis patient to erupt this serious producing blood coagulation and obstacle disease of DIC simultaneously; F : C/vWF: Ag and D-D have value of important differential diagnosis on diagnosis of hard compound of liver and DIC; Observing DIC continuous change about index dynamically helps to diagnose clearly and treat in time.
Keyword Liver cirrhosis Blood coagulation (DIC) in the disseminated blood vessel

Diagnosis and treatment of liver cirrhosis complicated by
disseminated intravascular coagulation
Wu Jianxin, Hu Ying, Shen Zhongmei, et al.
Dept.of Gastroenterology, Xinhua Hospital, Shanghai Second Medical University, Shanghai200092.
[Abstract] Objective It is quite difficult to make precise and early diagnosis of disseminated intrava cular coagulation( DIC) when liver cirrhosis is complicated by it.The authors studied some parameters related in bleeding and coagulation in order to find out how to diagnose and manage this severe complication in hepatopathy.M ethods A patient with liver cirrhosis had lung infection and admitted into hospital before ecchymosis of large areas, a trend towords bleeding, appeared.Laboratory parameters of bleeding and coagulation in relation with DIC were employed in succ ession and dynamically, including blood platelet, prothrombin time( PT) ,plasma fibrinogen fibrin( ogen) Degrada tion products (FDP) ,3P test, activated partial thromboplastin time( APTT) ,thrombin time( TT) ,F : C and F : C/vWF: Ag, D-dimer and euglobulin lysis time( ELT) . Results In the course of the disease, the count of blood platlet and the level of the plasma fibrinogen were progressively decreased while PT, APTT and TT were prolonged.Plasma F : C was reduced, and F : C/vWF: Ag, reduced much more significantly.But significant increase of D-dimer was demonstrated.Conclusion Disse minated intravascular coagulation, a part of severe coagulopathy, would be developed in liver cirrhosis with complications, such as infections.Emphasis should be put on the detection of plasma F : C/vWF: Ag and D-dime because of their important differential diagnotic value in cirrhosis with DIC.And succe S sive and dynamic investigation of those parameters is quite helpful for diagnosis and management.
Key words cirrhosis of the liver disseminated intravascular coagulation( DIC)
Hepatopathy can erupt blood coagulation (disseminated intravascular coagulation in the disseminated blood vessel simultaneously because of shock, infection, cancerous swelling,etc., DIC) . Caused by hepatopathy to happen while being many kinds of, the intersection of blood coagulation and synthetic and supersession obstacle of factor, in addition hepatopathy type, condition intensity and nonconformity that the condition develops, the patient's clinical manifestation is not often very typical, so as to diagnose and it is rather thorny to treat [1,2] . The author combines a case of liver hard compound and sub-acute DIC patient who the our academy accepted for medical treatment now, diagnose it and treat the report to analyze as follows.
A materials and method
1.1 Clinical materials patient, female, 66 years old, the native in Shanghai. July 1, 2002 because the sclera was yellow to dye to companions to cough for over 2 months, gi medicine of clouded in mind Shanghai second subsidiary Xinhua hospital of medical university of income of half a day. More than 2 months will come, it is dyed that patient's sclera is yellow slightly. The appetite is general, there is not abdominal distension. The low-heat appears behind a cold ' 37.5 - 38.0 ) , cough. The patient is infected with in the our academy " . For diagnose blood research room detect further, the intersection of blood coagulation and the intersection of pathological change and relevant index clearly. These indexes include the time of thrombinogen (PT, the first stage of law) , the time of enzyme (APTT, craft law) of activating some blood coagulation and living , thrombese time (TT, craft law) , fibrinogen (Fg, Clouse law) , fibrin ( Original) Degrade products (FDP, the agglutinate law of emulsion) , D - gather the body (D-D, ELISA law) two times , 3P test and excellent globulin dissolve, test , F: C and Von Willebrand factor (vWF: Ag, the second stage of law) , F: C/vWF: Ag ratio,etc..
1.2 Therapeutic method Patient behind admitted to hospitalling by employing heads of spore he pyridine, last chain amino acid, door amino acid potassium magnesium, grams secret Du winter - ( Fructose of milk) ,Complex of thrombinogen (PPSB) , it is albumin,etc. that treat, 3 days later, the patient coughs and disappears. But on the 9th day ' July 9) The large stretch of silt spot of left lower extremities appears, and expand to lower abdomen and left upper abdomen and left waist back rapidly, the intersection of right side and lower extremities and inject position appear the flaky silt spot. Hold a consultation through the intersection of our academy and the intersection of blood and internal medicine department, consider bleeding reason have 3 kind possible: ( 1) Liver cirrhosis, liver function are lost, compensated; ( 2) Liver cirrhosis erupts DIC simultaneously; ( 3) It is hyperfunction that it is dissolved that primary and fine.
2 results
2.1 The change of having dynamic index conventionally of patient's blood is shown in Table 1. The patient has accepted the blood transfusion of composition after being admitted to hospital ' Erythrocyte, blood platelet,etc.) ,But regular index WBC, RBC, Hb and PLT of the blood still presents the decline. Among them, PLT going on downward trend is especially obvious.
Dynamic change (omitted) of the index conventionally of patient's blood of Table 1
2.2 Blood coagulation relevant laboratory index and dynamic change appear and is shown in Table 2. Patient appear large stretch of skin lay day in spot such as silt since ' July 9) ,Publish, the intersection of blood coagulation and index it finds the change of the result to be relatively more complicated. This may have used blood plasma, fibrinogen, blood coagulation factor complex (PPSB) with this period When have something to do blood platelet. But the fibrinogen is very obvious to reduce compared with level when being admitted to hospital; Meanwhile, D - gather the increasing notably of body two times. On the other hand, F measured later: C, vWF: Ag and F: C/vWF: Ag change of ratio, and FDP increase extremely prominent even. Excellent globulin is dissolved and tested and has not continued measuring because of not quite thinking the meaning.
One, blood coagulation relevant laboratory index and dynamic change (omitted) of Table 2
Other: The patient's tumour mark thing AFP CEA CA19-9 is in the normal range; HBsAg( +) , HBeAb (+) , HBcAb (+) , HBV-DNA: 4.0* 10 7 Copy ml.
2.3 The result develops according to patient's condition and the laboratory index is changed, hold a consultation again, consider in order that liver cirrhosis, liver function are depleted amalgamates DIC. Then original to resist infection, protect liver, blood transfusion, the intersection of blood transfusion and little board, the intersection of blood coagulation and at the foundation factor, albumin,etc., have adjusted and treated the measure. Mainly adopt: ( 1) Avoid congealing rapidly ' Heparin) Anticoagulatory treatment, 50mg, every 12h1 time; ( 2) Lose the blood, 200ml/d, 4 days; ( 3) Fail freshly and do and freeze the blood plasma, 200ml/d; ( 4) Failed the blood coagulation factor ' Fibrinogen and, factor) When. Patient's lower extremities and belly and dorsal silt spot situation obviously disappear in 3- 4 days after treating project setting. However, patient's liver function worsens day by day, the going on intensification (TBI401.9 mol/L, CBI97.3 mol/L) of jaundice ,Appear ascites and encephalopathy, display, urine quantity is reduced. Hereafter, though would rather use hepatocyte growth factor, Yobo's thinking, Tate, brute force and strengthened, prevented and cured measures such as infecting, having an ease constipation, diuresis,etc., patient's condition has not still taken a favorable turn. In the morning of August 3, patients spittinged blood in a large amount suddenly, went through and died after all rescue measures proved ineffectual actively.
3 is discussed
It is not rare that liver cirrhosis erupts DIC simultaneously on clinic, but it is difficult to diagnose in time and deal with accurately. These patients' liver function is mostly worse, it is clinical and very apt to be inclined to the patient's bleeding with unusual happening, the blood coagulation index is depleted for worsening and liver function of liver function it [1,2] . On the other hand, the patient's individual differences of clinical manifestation are very inconsistent. Such as patient of this example, its DIC is shown as the sub-acute course, lasts one month, even more important reason is that serious hepatopathy is mixed with DIC together, in addition the application of different blood products
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