1978 Volume 9 Issue 2 Pages 208-212
Recently, growing interests had been devoted largely to disseminated intravascular coagulation (DIC), because of its frequency and clinical importance. It has been known that shock is a frequent complication of DIC, although it has not been elucidated whether shock is a cause of DIC rather than a result. This study was made to clarify relationship between DIC and shock in 699 consecutive autopsied cases, almost all of whom was over age sixty, in Tokyo Metropolitan Geriatric Hospital.
The diagnosis of DIC was established when coagulation analysis revealed presence of consumption coagulopathy. Among these cases, 106 had evidences of DIC and 30 had clinical and pathological findings highly suggestive of DIC although the coagulation findings were not specific. Shock was complicated in 38 of the former and 10 of the latter.
Eight of these 48 patients with DIC complicated with shock revealed consumption coagulopathy simultaneously with the development of shock. 24 cases had not clea r-cut evidences of DIC immediately after the development of shock in coagulation findings, although they showed marked coagulation abnormalities indicating DIC after the shock developed. 44% of conditions associated with the shock in these patients was gram-negative septicaemia. The other underlying pathologic conditons in these cases consisted of cancer, peptic ulcer, acute myocardial infarction and pneumonia.
Onset of shock was observed in 16 cases in whom diagnosis of DIC had been already established by coagulation analysis. 11 cases of these had cancer with metastases, primary organs of which were stomach, colon or biliary tracts. 70% of these patients were febrile.
Acute renal failure, purpura, petechiae, melena, coma, epileptic seizure, systemic peripheral gangrene and/or red cell fragmentation in peripheral blood smear were main symptoms in DIC with shock. Four cases, excluding two cases in whom DIC developed following development of acute myocardial infarction, showed ECG findings indicating development of acute myocardial infartion, although myocardial infarction was evident in only one cases by postmortem examination.
Presence of fibrin thrombi was confirmed in 36 cases out of the 48 autopsied cases with DIC accompained with shock. Terminal hemorrhagic necrotizing enteropathy was observed in 15 of those cases. Hemorrhage from adrenal was observed in 4 cases.
From these results, it is concluded that shock does frequently cause DIC and that shock in gram-negative septicaemia is especially important because of its high incidence to result DIC.
