الفهرس 
ASSOCIATED CLINICALOnly 14 pages are availabe for public view
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Abstract
The main role of the anesthesiologist in a patient with DIC is to have adequate intravenous access and to assist in providing supportive blood product replacement. At least two 18-gauge intravenous catheters are necessary for this purpose. Management of DIC consists of treating the underlying cause, maintenance of blood volume, and replacement of depleted clotting factors( Hepner et al . ,2004 ).
The main goal of treatment of DIC is removal or correction of the underlying cause with restoration of circulating blood volume and replacement of blood components and clotting factors as indicated ( Wali et al ., 2004 ).
The American Society of Anesthesiologists (ASA) has developed guidelines regarding blood component therapy. Their recommendations for red blood cell (RBC) transfusion include transfusion of RBC when hemoglobin falls below 6 g/dL, especially when blood loss is acute. Transfusion of RBC for hemoglobin (Hb) levels between 6 and 10 mg/dL should be based on the woman’s risk for complications because of reduced oxygenation. Transfusion of one unit of packed red cells generally increases Hb by 1 g/dL or the hematocrit by 3%. Platelet transfusion is recommended in surgical and obstetric cases with a platelet count less than 50×103 if microvascular bleeding is present. With abnormal coagulation and low levels of fibrinogen, replacement of coagulation factors is necessary.
Fresh-frozen plasma contains all the clotting factors except platelets. Most of the factors are stable in stored blood with two exceptions: factors V and VIII. Factors V and VIII are not stable in stored blood and decrease to 15% and 50% of normal, respectively, after 21 days storage. Packed RBCs have even fewer coagulation factors; consequently, FFP is recommended if
(1) Generalized bleeding cannot be controlled with surgical hemostasis or cautery
(2) PTT is at least 2 times control or more
(3) Factors V and VIII are deficient, based on laboratory evidence. However, factors V and VIII rarely decrease below those levels required for hemostasis.
If FFP transfusion cannot maintain fibrinogen levels above 0.5 g/L, cryoprecipitate, which contains a greater portion of fibrinogen than FFP, should also be given. The administration of cryoprecipitate for treatment of DIC associated with placental abruption has been shown to increase plasma fibrinogen levels ( Wali et al ., 2004 ) .
Fibrinogen seems to be the commonest procoagulant needed in obstetric hemorrhage with DIC. Serial determination of fibrinogen level is a sensitive indicator of DIC. Approximately 4 g of fibrinogen are required to increase the fibrinogen concentration by 100 mg/dL in a healthy 70-kg adult. Fibrinogen may be administered in the form of cryoprecipitate or fresh-frozen plasma (FFP). Cryoprecipitate contains 3- to 10-fold more fibrinogen per unit volume as compared to FFP.
Each bag of cryoprecipitate contains fibrinogen (250–300 mg), factor VIII, von Willebrand factor, and factor XIII in 15 to 25 mL plasma. Thus, 13 to 16 bags of cryoprecipitate are needed to increase the fibrinogen concentration by 100 mg/dL.; the fibrinogen level of 100 mg/dL safely produces hemostasis in the nonpregnant individual. A fibrinogen level of 150 to 200 mg/dL is probably necessary to prevent hemorrhage in the obstetric population. Cryoprecipitate, frozen and stored at - 19°C, must be thawed for 30 to 40 min at 37°C before use.( Wali et al ., 2004 )
Anticoagulants have been discussed before but they are of a little use intraoperativly as the most common DIC symptom is hemorrhage. (Wali et al ., 2004 )