Elsevier

Critical Care Clinics

Volume 13, Issue 3, 1 July 1997, Pages 591-609
Critical Care Clinics

ETIOLOGY AND TREATMENT OF ACQUIRED COAGULOPATHIES IN THE CRITICALLY ILL ADULT AND CHILD

https://doi.org/10.1016/S0749-0704(05)70330-4Get rights and content

Coagulation and bleeding abnormalities represent one of the major problems commonly encountered in critically ill patients irrespective of age. Although most of these patients have no intrinsic abnormalities of hemostasis, either their underlying disease or the therapy of the disease may produce clinically significant bleeding problems. The intensive care physician must be able to recognize these abnormalities quickly and address them before clinically significant problems arise. Failure to do so may result in added costs and a significant increase in morbidity in the acutely ill patient. Coagulation disorders can be divided into several different categories as follows31, 46:

Section snippets

CONSUMPTIVE COAGULOPATHIES

These disorders are characterized by the abnormal consumption of clotting factors, and at times platelets, with bleeding occurring as a consequence of this consumption. The classic example of this type of disorder is disseminated intravascular coagulation (DIC), because clotting factors, platelets, and red cells are consumed in this entity. Other examples of consumptive processes in which only some elements are consumed are fibrin(ogen)olysis (fibrinogen); thrombotic thrombocytopenic purpura

IATROGENIC COAGULOPATHIES

Iatrogenic disorders result from prior or ongoing medical intervention. The clearest example of this is an anticoagulant overdose with heparin or warfarin. Such an overdose can occur if concurrent medical therapy results in an enhanced action of the drug through an effect on drug clearance or metabolism. Clinically significant coagulopathies can also occur by drug activation of fibrinolysis20 or through the wash-out of clotting factors and platelets in the course of a patient receiving multiple

CONCLUSION

Bleeding is an uncommon primary, though common secondary, cause of morbidity in critically ill patients. Except in those patients known to have an underlying inherited coagulopathy (e.g., hemophilia), the cause of bleeding in these patients is generally a secondary manifestation of their underlying disease process. As such, it is often multifactorial and the physician caring for these patients must efficiently and accurately determine the cause(s) of the bleeding in order to provide appropriate

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    Address reprint requests to Robert I. Parker, MD, Department of Pediatrics, HSC T-11 Room 060, S.U.N.Y. at Stony Brook, Stony Brook, NY 11794–8111

    *

    From the Department of Pediatrics, Division of Hematology/Oncology, State University of New York at Stony Brook, Stony Brook, New York

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