PO0030 - Successful Treatment of Disseminated Intravascular Coagulation (DIC) in Patients with Obstetric Pathology and Acute Promyelocytic Leukemia (APL): A Case Series

Background: Natural anticoagulants deficiency and hyperfibrinolysis are among the main features of DIC.

Aims: To present successful management of 3 cases of patients with full-blown DIC.

Methods: Full blood count, hematological tests, thromboelastogram (TEG) were done.

Results: Case 1: 28-year-old lady after hysterectomy presented DIC with massive bleeding on skin and mucous membranes with bloody drains discharge. Laboratory tests: platelets - 28x109/L, activated partial thromboplastine time (APTT) - 124 sec, Quick prothrombin test (QPT) - 22%, fibrinogen - 0.7 g/L, D-dimers - 5200 µg/L, antithrombin (AT) III - 43%. The clot wasn’t formed at TEG. Prothrombin complex concentrate 30 IU/kg intravenously (iv), donor platelets, fresh frozen plasma (FFP) 15 mL/kg/day iv, cryoprecipitate iv were used. Bleeding stopped in a day, platelets stabilized at >100x109/L, fibrinogen - at > 1.5 g/L, normocoagulation was achieved. Case 2: 30-year-old woman after abortion at 12 weeks of gestation with sepsis developed DIC without bleeding. Her platelets were 81x109/L, APTT - 54 sec, QPT - 56%, fibrinogen - 1.2 g/L, D-dimers - 1400 µg/L, AT III - 68%. Treatment included FFP 15 ml/kg/day. Normalization of APTT and QPT was achieved in a day. Case 3: 30 years old man with APL had DIC with fibrinolytic phenotype after chemotherapy with massive skin and mucous bleeding. Tests showed platelets - 31x109/L, APTT - 64 sec, QPT- 52%, fibrinogen -1.2 g/L, D-dimers - 4800 μg/L, AT III - 53%, the clot was lysed by 30 min at TEG. Donor platelets, FFP 15 ml/kg/day, tranexamic acid 25 mg/kg iv were used in treatment. Bleeding stopped in 2 days, normalization of APTT and QPT, TEG and fibrinogen > 1.5 g/L was achieved.

Conclusion(s): Pathogenic therapy of DIC is based on the assessment of hemostasis along with clinical manifestations and includes use of blood components and fibrinolysis inhibitors.