Yıl: 2014 Cilt: 39 Sayı: 3 Sayfa Aralığı: 488 - 495 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması

Öz:
Amaç : Travmatik hasar, dissemine intravasküler koagülasyonun (DIK) en önemli nedenlerindendir. Kan kaybı ve sıvı yüklemeye ikincil hemodilüsyona bağlı olarak gelişir. Travma ilişkili DIK gelişimi insidansı özellikle kranioserebral travmalarda (KST) daha yüksektir. KST ilişkili DIK'in klinik sonuçlarının kötü sonuçlandığı literatürde ortaya konmuş olmakla birlikte patofizyolojisi ile ilgili bilgi kısıtlıdır. Beyin dokusunda prokoagülan moleküllerin zenginliği nedeniyle KST ile DIK gelişimi yakından ilişkilidir. Materyal ve Metod: Bu çalışmada acil servise başvuran 30 travma hastasının hastaneye başvuru zamanında ve 5. günde koagülasyon çalışmaları yapıldı. Ekstrakranial travmalı hasta grupları ile KST'lı hasta gruplarına ait koagülasyon testleri yapılarak iki grup üzerinden DİK değerlendirildi. Bulgular: Travma sebepleri arasında trafik kazaları ilk sırada, kurşun yaralanması ikinci sırada izlendi. Travmaların %53.4'ü kranial (A grubu), %23.3'ü kranial ve ekstrakranial (B grubu), %23.3'ü ekstrakranial özellikteydi (C grubu). 30 olgudan 5'inde (%16.7), en sık B grubuna dahil olgularda (%42.9) DIK tablosu gelişti. Tartışma: Kranial ve kranial-ekstrakranial travmalı hastalarda daha sıklıkla koagülasyon testlerinde anormallik olduğu saptandı. Özellikle protrombin zamanı, fibrinojen miktar tayini, periferik yayma sonuçları, Faktör 5 ve FDP değerleri DİK tanısında önemli olduklarından, çalışmamızda bu testlerde büyük oranda bozukluk olduğu görüldü. Bunun ise beyin lezyonları ile ilişkili olabileceği sonucuna varıldı.
Anahtar Kelime:

Konular: Hematoloji

Evaluation of Disseminated Intravascular Coagulation in the Craniocerebral Traumas

Öz:
Purpose: Traumatic injury is one of the most important cause of disseminated intravascular coagulation (DIC). It occurs because of blood loss and hemodilution due to fluid resuscitation. The incidence of trauma associated DIC is mainly higher in the craniocerebral traumas. Even though craniocerebral trauma related DIC is well defined, the pathophysiology has been poorly characterized in the literature. Due to the fact that brain tissue is highly significant for procoagulant molecules, craniocerebral traumas are closely related to DIC. Material and Methods: In the current study, 30 patients admitted to emergency room have been considered on the first and fifth day of admission to the hospital for the coagulation tests to evaluate DIC in both two groups. Results: Traffic accidents were regarded as the first reason gunshot wounds however as second reason among the causes of trauma. Percentages of cranial (A group), extracranial (B group) and extracranial (C group) properties of trauma were 53.4%, 23.3% and 23.3%, respectively. In 5 of 30 cases DIK table was most frequently observed in patients included in group B (42.9%). Conclusion: Abnormalities were more frequently detected in coagulation tests of cranial and cranial-extracranial trauma patients. In our study, some tests, especially prothrombin duration, fibrinogen assay, peripheral blood smear results, Factor 5 and FDP values, were found to be largely disorder due to their importance in diagnosis of DIC. It was concluded that this may be associated with brain lesions.
Anahtar Kelime:

Konular: Hematoloji
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Davis DP, Kene M, Vilke GM, et al. Head-injured patients who "talk and die": the San Diego perspective. J Trauma. 2007;62:277-81.
  • Lannoo E, Van Rietvelde F, Colardyn F, et al. Early predictorsof mortality and morbidity after severe closed head injury. J Neurotrauma. 2000;17:403-14.
  • Demetriades D, Kuncir E, Murray J, Velmahos GC, Rhee P, Chan L. Mortality prediction of head abbreviated injury score and Glasgow coma scale: analysis of 7,764 head injuries. J Am Coll Surg. 2004;199:216-22.
  • Demetriades D, Kuncir E, Velmahos GC, Rhee P, Alo K, Chan LS. Outcome and prognostic factors in head injuries with an admission Glasgow coma scale score of 3. Arch Surg. 2004;139:1066-8.
  • Marder VJ, Feinstein DI, Francis CW, Colman RW. Consumptive thrombohemorrhagic disorders. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds.Hemostasis and thrombosis: basic principles and clinical practice. 3rd ed. Philadelphia: J.B. Lippincott. 1994:1023-63.
  • Mller-Berghaus G, ten Cate H, Levi MM. Disseminated intravascular coagulation. In: Verstraete M, Fuster V, Topol EJ, eds. Cardiovascular thrombosis: thrombocardiology and thromboneurology. 2nd ed. Philadelphia: Lippincott- Raven. 1998:781-801.
  • Gando S, Kameue T, Nanzaki S, Nakanishi Y. Disseminated intravascular coagulation is a frequent complication of systemic inflammatory response syndrome. Thromb Haemost 1996;75:224-8.
  • Thijs LG, de Boer JP, de Groot MCM, Hack CE. Coagulation disorders in septic shock. Intensive Care Med 1993;19:8-15.
  • Colman RW, Rubin RN. Disseminated intravascular coagulation due to malignancy. Semin Oncol. 1990;17:172-86.
  • Sarris AH, Kempin S, Berman E, et al. High incidence of disseminated intravascular coagulation during remission induction of adult patients with acute lymphoblastic leukemia. Blood. 1992;79:1305-10.
  • Sarris AH, Kempin S, Berman E, et al. High incidence of disseminated intravascular coagulation during remission induction of adult patients with acute lymphoblastic leukemia. Blood. 1992;79:1305-10.
  • Szlachetka DM. Kasabach-Merritt syndrome: a case review. Neonatal Netw 1998;17:7-15. [
  • Aboulafia DM, Aboulafia ED. Aortic aneurysm- induced disseminated intravascular coagulation. Ann Vasc Surg 1996;10:396-405. Ruggenenti P, Lutz J, Remuzzi G. Pathogenesis and treatment of thrombotic microangiopathy. Kidney Int Suppl. 1997;58:97-101.
  • Furlan M, Robles R, Galbusera M, et al. Von Willebrand factor -Dcleaving protease in thrombotic thrombocytopenic purpura and the hemolytic?uremic syndrome. N Engl J Med 1998;339:1578-84
  • Pondaag W. Disseminated intravascular coagulation related to outcome in head injury. Acta Neurochir Suppl (Wien). 1979;28:98-102.
  • Kaufmann HH, Mattson JC. Coagulopathy in head injury. In: Becker DP, Povlishock JT, eds. Central Nervous System Trauma Status Report. Bethesda, MD: National Institute of Neurological and Communicative Disorders and Stroke. 1985:187- 206.
  • Selladurai BM, Vickneswaran M, Duraisamy S, Atan M. Coagulopathy in acute head injury--a study of its role as a prognostic indicator. Br J Neurosurg. 1997;11:398-404.
  • Kushimoto S, Yamamoto Y, Shibata Y, Sato H, Koido. Implications of excessive fibrinolysis and alpha(2)-plasmin inhibitor deficiency in patients with severe head injury. Neurosurgery. 2001;49:1084-90..
  • Kearney TJ, Bentt L, Grode M, Lee S, Hiatt JR, Shabot MM. Coagulopathy and catecholamines in severe head injury. J Trauma. 1992;32:608-12.
  • Colman RW, Rabboy SJ, Minna J.D. Disseminated intravascular coagulation (DIC): An approach. Am. J. Med. 1972;52:679-89.
  • Wafaisade, A., Wutzler, S., Lefering, R., Tjardes, T., Banerjee, M., Paffrath, T., Bouillon, B., and Maegele, M. Drivers of acute coagulopathy after severe trauma: a multivariate analysis of 1987 patients. Emerg. Med. J. 2010;27:934-9.
  • Maani, C.V., DeSocio, P.A., and Holcomb, J.B. Coagulo- pathy in trauma patients: what are the main influence factors? Curr. Opin. Anaesthesiol. 2009;22:255-60.
  • Mitra, B., Cameron, P.A., Mori, A., Maini, A., Fitzgerald, M., Paul, E., and Street, A. (2011). Early prediction of acute traumatic coa- gulopathy. Resuscitation. 2011;82:1208-13.
  • Laroche M, Kutcher ME, Huang MC, Cohen MJ, Manley GT. Coagulopathy after traumatic brain injury (Review) Neurosurgery. 2012;70:1334-45.
  • Pazzaglia P, Frank G, Frank F et al. Clinical course and prognosis of acute post- traumatic coma. J. Neurol. Neurosurg. Psychiatry. 1975;38:149-54.
  • Takashima S, Koga M, Tanaka K. Fibrinolytic activity of human brain and cerebrospinal fluid. Br J Exp Pathol. 1969;50:533-9.
  • Tovi D. Fibrinolytic activity of human brain. A histochemical study. Acta Neurol Scand. 1973;49:152-62.
  • Clark JA, Finelli RE, Netsky MG. Disseminated intravascular coagulation following cranial trauma. Case report. J Neurosurg. 1980;52:266-9.
  • Goodnight SH, Kenoyer G, Rapaport SI, Patch MJ, Lee JA, Kurze T. Defibrination after brain-tissue destruction: A serious complication of head injury. N Engl J Med. 1974;290:1043-7.
  • Druskin MS, Drijansky R. Afibrinogenemia with severe head trauma. JAMA. 1972;219:755-6.
  • Talving P, Benfield R, Hadjizacharia P, Inaba K, Chan LS, Demetriades D. Coagulopathy in severe traumatic brain injury: a prospective study. J Trauma. 2009 Jan;66(1):55-61; discussion 61-2. doi: 10.1097/TA.0b013e318190c3c0.
  • Olson JD, Kaufman HH, Moake J, et al. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989;24:825- 32.
  • Olson JD, Kaufman HH, Moake J, et al. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989;24:825- 32.
  • Pondaag W. Disseminated intravascular coagulation in head injured patients. Advanced in Neurosurgery 6. Treatment of hydrocephalus Computer Tomographyi Springer Verlag, Heidelberg, New York. 1978;159-62.
APA ALTINEL F (2014). Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. , 488 - 495.
Chicago ALTINEL FARUK Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. (2014): 488 - 495.
MLA ALTINEL FARUK Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. , 2014, ss.488 - 495.
AMA ALTINEL F Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. . 2014; 488 - 495.
Vancouver ALTINEL F Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. . 2014; 488 - 495.
IEEE ALTINEL F "Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması." , ss.488 - 495, 2014.
ISNAD ALTINEL, FARUK. "Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması". (2014), 488-495.
APA ALTINEL F (2014). Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. Çukurova Üniversitesi Tıp Fakültesi Dergisi, 39(3), 488 - 495.
Chicago ALTINEL FARUK Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. Çukurova Üniversitesi Tıp Fakültesi Dergisi 39, no.3 (2014): 488 - 495.
MLA ALTINEL FARUK Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. Çukurova Üniversitesi Tıp Fakültesi Dergisi, vol.39, no.3, 2014, ss.488 - 495.
AMA ALTINEL F Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. Çukurova Üniversitesi Tıp Fakültesi Dergisi. 2014; 39(3): 488 - 495.
Vancouver ALTINEL F Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması. Çukurova Üniversitesi Tıp Fakültesi Dergisi. 2014; 39(3): 488 - 495.
IEEE ALTINEL F "Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması." Çukurova Üniversitesi Tıp Fakültesi Dergisi, 39, ss.488 - 495, 2014.
ISNAD ALTINEL, FARUK. "Kranioserebral Travmalarda Dissemine Koagülasyon İntravasküler Araştırılması". Çukurova Üniversitesi Tıp Fakültesi Dergisi 39/3 (2014), 488-495.