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CCC SIRS, ARDS and DIC following ischemic stroke in a patient with SLE

CCC SIRS, ARDS and DIC following ischemic stroke in a patient with SLE. LeeChuy, Katherine Lee, Sidney Abert Lerma, Daniel Joseph Legaspi, Roberto Jose Li, Henry Winston Li, Kingbherly Lichauco, Rafael Lim, Imee Loren Lim, Jason Morven Lim, John Harold Lim, Mary Lim, Phoebe Ruth

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CCC SIRS, ARDS and DIC following ischemic stroke in a patient with SLE

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  1. CCCSIRS, ARDS and DIC following ischemic stroke in a patient with SLE LeeChuy, Katherine Lee, Sidney Abert Lerma, Daniel Joseph Legaspi, Roberto Jose Li, Henry Winston Li, Kingbherly Lichauco, Rafael Lim, Imee Loren Lim, Jason Morven Lim, John Harold Lim, Mary Lim, Phoebe Ruth Lim, Syndel Raina Lipana, Kirk Andrew Liu, Johanna Llamas, Camilla Alay

  2. 1. What are the risk factors for thrombosis in SLE?

  3. Demographic characteristics • Age, gender, ethnicity • Increased prevalence of traditional cardiovascular risk factors • Hypertension, diabetes mellitus, proatherogenic lipid profile, elevated homocysteine levels, obesity, sedentary lifestyle, early menopause • Acquired thrombosis triggers • Smoking, oral contraceptives, hormone replacement therapy, pregnancy, prolonged hospitalization, immobilization, surgical procedures • Genetic hypercoagulable states Erkan, Doruk.(2006) Editorial: Lupus and thrombosis, The Journal of Rheumatology 2006; 33:9, retrieved on September 28, 2010 from: http://www.jrheum.com/subscribers/06/09/1715.html

  4. Acquired lupus-specific risk factors • Chronic inflammation, renal disease, corticosteroid use (controversial), vasculitis, Libman-Sacks endocarditis, anti-oxidized LDL antibodies, elevated C-reactive protein and proatherogenic cytokines • Persistent antiphospholipid antibodies • Positive lupus anticoagulant test, moderate-to-high titer anticardiolipin and anti-ß2-glycoprotein-I antibodies Erkan, Doruk.(2006) Editorial: Lupus and thrombosis, The Journal of Rheumatology 2006; 33:9, retrieved on September 28, 2010 from: http://www.jrheum.com/subscribers/06/09/1715.html

  5. 2. Describe the pathophysiology of SIRS

  6. Mark S. Klempnernetal. Case 25-2010: A 24-Year-Old Woman with Abdominal Pain and Shock. new england journal of medicine 363;8 august 19, 2010

  7. 3. Define ARDS

  8. Acute Respiratory Distress Syndrome • A clinical syndrome of severe dyspnea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure. http://www.harrisonspractice.com/practice/ub/view/Harrisons%20Practice/141281/all/Acute_Respiratory_Distress_Syndrome

  9. 4. Describe the pathomechanisms in DIC

  10. Pathomechanisms in DIC • acute, subacute, or chronic thrombohemorrhagic disorder characterized by the excessive activation of coagulation, which leads to the formation of thrombi in the microvasculature of the body • Two major mechanisms: (1) release of tissue factor or thromboplastic substances into the circulation, and (2) widespread injury to the endothelial cells Robbins and Cotran Pathologic Basis of Disease, 8th ed.

  11. Pathomechanisms in DIC Endothelial Injury • Exposure of subendothelialmatrix leads to activation of platelets & both coagulation pathways • Increased TNF in sepsis • induces endothelial cells to express tissue factor on their cell surfaces & to decrease the expression of thrombomodulin • upregulates expression of adhesion molecules on endothelial cells, promoting the adhesion of leukocytes (ROS & preformed proteases) Robbins and Cotran Pathologic Basis of Disease, 8th ed.

  12. Pathomechanisms in DIC Endothelial Injury • Deposition of antigen-antibody complexes (e.g., systemic lupus erythematosus), temperature extremes (e.g., heat stroke, burns), or microorganisms (e.g., meningococci, rickettsiae) • Subtle endothelial injury causes coagulation by enhancing membrane expression of tissue factor Robbins and Cotran Pathologic Basis of Disease, 8th ed.

  13. Pathomechanisms in DIC Consequences of DIC • Widespread deposition of fibrin • ischemia • microangiopathichemolytic anemia • Consumption of platelets & clotting factors, & activation of plasminogen • Plasmin cleaves fibrin & digests factors V and VIII • Fibrin degradation products resulting from fibrinolysis inhibit platelet aggregation, fibrin polymerization, and thrombin • hemorrhagic diathesis Robbins and Cotran Pathologic Basis of Disease, 8th ed.

  14. Pathophysiology of DIC Robbins and Cotran Pathologic Basis of Disease, 8th ed.

  15. 5. Enumerate the risk factors for SIRS, ARDS and DIC and cite those that are present in the patient

  16. Risk factors for ARDS • The risk of developing ARDS are increased in patients suffering from more than one predisposing medical or surgical condition • OTHERS • older age • chronic alcohol abuse, metabolic acidosis • Use of mechanical ventilator • Heavy drinker • severity of critical illness

  17. Risk factors for SIRS • young and elderly people • Severe trauma • Complication of Surgery • Burns • Immunodeficiency (Treatment with chemotherapy drugs or radiation) • Transplantation • People with long-standing diabetes, AIDS, or cirrhosis • Infection such as: • Pneumonia • Meningitis • Cellulitis • Urinary tract infection • Ruptured appendix • Acute pancreatitis

  18. Risk factors for DIC

  19. Risk factors present in the patient

  20. 6. Outline the management of febrile neutropenia

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