CARE OF THE CRITICALLY ILL CHILD: THE PROBLEM OF DISSEMINATED INTRAVASCULAR COAGULATION

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Abstract
A critically ill child should be suspected of the complication of disseminated intravascular coagulation when evidence of the following signs and symptoms are present: (1) the potential of a triggering substance or event such as endotoxin, tissue thromboplastin (damaged tissue), endothelial damage, or proteolysis; (2) multiple system involvement producing coma, renal shutdown, respiratory disease, and shock; (3) a bleeding diathesis; and (4) a hemolytic anemia associated with fragmented and burred red cells. Laboratory confirmation should include evidence for depletion of coagulation factors consumed during clotting (i.e., platelets, fibrinogen, and factors II, V, and VIII). Treatment consists of heparinization, replacement of depleted factors if needed, and supportive care, which includes removal of the triggering event.

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