girl^interrupted
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Pt with DIC, what is most likely to be seen in the pt:
INCREASE THROMBOSIS?
INCRESE FIBRINOGEN?
INCREASE PLASMIN?
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| Ancylostoma
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decrease fibrinogen , increase d dimer or fibrin breakup products, increase pt, increase ptt, prolonged bleeding time
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| girl^interrupted
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yes...but out of these choices...
Plasmin?
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| Ancylostoma
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since we have an increase in fibrin breakup products, I assume an increase in plamin. Not sure but that would be my reasoning
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| Ancylostoma
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looking it up on the internet is say the hemmorhagic variety is due to increase plasmin
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| new_n_lost
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Of the Choices given OfCourse
A Inc. Thrombosis -----> Shud be the Pt is in DIC there has to be More Thrombosis
B. Inc . Fibrinogen -----> Incorrect Dec. levels r seen.
C. Inc. Plasmin --------> Well it Plays a Important role in Fibrinolysis but i think its not Imp for Diagnosis of DIC
Reason 1:- http://www.medscape.com/files/emedicine/dissemina...
- Fibrin and fibrinogen degradation products
- Latex particle agglutination test is used to detect fibrinogen and fibrin degradation products (FDPs).
- Degradation products increase as plasmin biodegrades fibrinogen and fibrin.
- This test is not diagnostic of DIC, yet levels are elevated in 85-100% of patients.
Reason 2 :- http://www.aic.cuhk.edu.hk/web8/DIC.htm
FDP elevated in 85-100%. Indicative of the presence of plasmin but not necessarily of intravascular coagulation. Also elevated in women using oral contraceptives, PE, some patients with MI, certain renal diseases, and patients with arterial or venous thromboembolic disease. May be normal. Test only measures D & E fragments. In some cases of DIC there is minimal secondary fibrinolytic response and thus there may be degradation only to X fragment stage. Alternatively if there is massive fibrinolysis degradation beyond the D & E fragment stage may occur
fibrinolytic system assays: - intensity of secondary fibrinolytic response is of clinical consequence for predicting potential microvascular thrombosis. If there is impaired activation end-organ damage may be greater
- elevated plasmin and decreased plasminogen provide direct evidence of fibrinolytic activation
- a2-plasmin inhibitor. Fast acting inhibitor of plasmin. If markedly elevated there may be ineffective fibrinolysis. Decrease provides indirect evidence of fibrinolytic activation and inhibitor consumption. Elevated plasmin a2 plasmin inhibitor complex (PAP) provides direct evidence of both fibrinolytic activation and inhibitor consumptio
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| new_n_lost
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So my Contention is that we will find more Thrombosis in DIC rather than INC. Plasmin Levels which also not so very diagnostic of DIC.
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| girl^interrupted
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Not very diagnostic but raised in 85-100% pts means pretty diagnostic to me....
As for thrombosis...cant a LOTTTTT of conditions have it?
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| new_n_lost
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the Question Says HE is IN DIC did they mention whether it was Acute or Chronic Cos in Chronic DIC there is more of a Micro-Vascular Thrombosis. So from the Choices i thought maybe Thrombosis.
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| new_n_lost
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Buddy i can give u a list of Conditions where Inc. Plasmin Conc is present.
But Still its my opinion only
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| usmle4me
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nicely explained. Agree with thrombosis
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| girl^interrupted
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plz take time to read this abstract....
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd...
The summary is:
We investigated the imbalance between thrombin and plasmin activity in vivo with various grades of severity of disseminated intravascular coagulation (DIC) in relation to the underlying diseases.
IF DIC is severe: plasmin activity more prominent
If DIC moderate: Thrombin activity more prominent...
Plz comment...
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| new_n_lost
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Agreed on the Research we r having both Increased Activity of Both Thrombin n Plasmin then there shud be a rise in Plasmin levels as well as Thrombin levels then from considering from the Choices abv , U R RIGHT THEN Thanks for taking out the time to search the Topic Totally Appreciatee it.!!!!!
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