Department of Haematology, University College London Hospital, London, UK.
Cardiometabolic Programme-NIHR UCLH/UCL BRC, London, UK.
Br J Haematol. 2019 Apr;185(2):209-218. doi: 10.1111/bjh.15821. Epub 2019 Mar 3.
Sepsis may be associated with activation of the coagulation system and, in its most severe form, may result in disseminated intravascular coagulation (DIC). Initially, there is thrombosis primarily affecting small and medium sized vessels and contributing to organ dysfunction, but continued activation results in consumption of coagulation factors. This results in prolongation of global coagulation parameters. Often thrombocytopenia is the initial feature in sepsis, which may be followed by prolongation of global coagulation assays, and in severe cases, associated with hypofibrinogenaemia, with overactivation of the fibrinolytic path. The end result is a bleeding phenotype. Scoring systems can be used to help identify patients at risk of DIC and aid in confirming a diagnosis of DIC utilising routine laboratory parameters. Discussion includes medical and blood product support of haemostasis, from thrombotic to bleeding states, in relation to sepsis trigger.
败血症可能与凝血系统的激活有关，在其最严重的形式下，可能导致弥散性血管内凝血（DIC）。最初，主要影响中小血管的血栓形成会导致器官功能障碍，但持续的激活会导致凝血因子的消耗。这会导致整体凝血参数的延长。在败血症中，血小板减少通常是最初的特征，随后可能会出现整体凝血检测的延长，在严重的情况下，还会伴有纤维蛋白原减少症，并伴有纤维蛋白溶解途径的过度激活。最终结果是出血表型。评分系统可用于帮助识别有发生 DIC 风险的患者，并利用常规实验室参数辅助确诊 DIC。讨论包括与败血症诱因相关的从血栓形成到出血状态的止血的药物和血制品支持。
