Intravascular coagulation and fibrinolysis.

Intravascular coagulation occurs as a sequela of many diverse conditions and may vary greatly in clinical and laboratory manifestations. The essence of the problem is that plasma is converted to serum in the circulation. As a result, both hemorrhagic and thrombotic events may occur. Platelet count and fibrinogen determination are the most important diagnostic tests. If values are abnormal, tests for fibrin (fibrinogen) degradation products are indicated. The first step in management is to identify and attempt to eliminate the underlying cause. Heparin therapy should be considered, particularly when clotting and severe fibrinolysis are both present. Replacement of clotting factors may be considered, but its value is a matter of debate.