Clinicopathological Correlations of Disseminated Intravascular Coagulation in Patients with Head Injury

Abstract

To try to define the significance of disseminated intravascular coagulation (DIC) in head-injured patients, we correlated clinical, laboratory, and pathological findings in 16 patients with head injury as their main problem who had DIC, who died within 4 days of injury, and who were examined postmortem. Patients were ranked according to the number of abnormal laboratory screening tests for DIC and the severity of these abnormalities. The most frequently abnormal laboratory tests were the fibrinogen degradation products and fibrinogen, followed in order by the activated partial thromboplastin time, prothrombin time, and thrombin time. The platelet count was the least abnormal value. The patients with the fewest abnormalities had the least abnormal computed tomographic scans. Autopsy reports revealed necrosis and bleeding in the brain and in a number of other organs, particularly the lungs. Microthrombi were not reported in the original autopsy reports. However, when these cases were reevaluated and their slides were stained with an immunoperoxidase technique using rabbit anti-human fibrinogen antiserum, microthrombi were seen frequently. Large microthrombi were more common in patients who had died within less than 24 hours, suggesting a relationship to death or to less time for lysis. In order of frequency, the brain/spinal cord, liver, lungs, kidneys, and pancreas were most commonly affected, and the liver, pituitary gland, pancreas, thymus, brain/spinal cord, large intestine, kidneys, and lungs had the greatest density of microthrombi. Pulmonary dysfunction had been a frequent problem in these patients, which may have been related to the high incidence of microthrombi and bleeding found in the lungs.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Coagulopathy in Isolated Blunt Traumatic Brain Injury

“…While we report a threefold increase in overall in-hospital mortality, this rate may increase up to ten times as shown in a recent prospective clinical trial [13]. The higher rate of single (SOF) and multiple organ failure (MOF) in the presence of acute posttraumatic coagulopathy corresponds to previous studies in which coagulation disorders after TBI were linked to ongoing hemorrhage, thromboembolic infarction, and organ necrosis [30,31]. These events may also contribute to a negative neurological prognosis [6].…”

Abnormal Coagulation during Pediatric Craniofacial Surgery

“…Disruption of the blood brain barrier and exposure of brain tissue factor might lead to activation of coagulation and disseminated intravascular coagulation [23, 24]. Massive tissue factor activation was unlikely in our study patients because factor VIIa levels remained relatively unchanged during surgery and were similar between groups.…”

“…We hypothesized that should abnormal hemostatis occur, the most likely causative mechanisms would involve one or more of the following: (1) hyperfibrinolysis [22]; (2) disseminated intravascular coagulation [23, 24], and (3) thrombocytopenia [25]and/or coagulation factor deficiency [26, 27]as a consequence of massive blood transfusion. The aim of our prospective study was to determine whether abnormal hemostatis occurs in children undergoing major craniofacial surgery and to characterize the nature of any coagulopathy found.…”

Coagulopathy predicts poor outcome in traumatic brain injury

“…Brain tissue is rich in thromboplastin, and activation of clotting pathways following TBI is thought to occur leading to abnormal coagulation. This may result in disseminated intravascular coagulation, cerebral microthrombi and ischaemia, or exacerbation of intracranial haemorrhage [4,5]. We have studied the admission International Normalised Ratio (INR) in moderate to severe TBI patients, examining its role as a prognostic indicator in these patients.…”