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0:00
Good day, this is Marcel Levi,
from the Academic Medical Center
of the University of Amsterdam
in the Netherlands.
And I'm going to present a talk
on the coagulopathy
associated with sepsis.
0:13
In systemic inflammatory states,
as may be the case in patients
with severe infection
or even sepsis,
there is always some degree
of coagulation activation.
This can be detected
when you use sensitive assays
for molecular markers
of activated coagulation factors
or pathways.
But if it's sufficiently severe,
you're also going to see
laboratory abnormalities
in routine coagulation tests
like the platelet count
or prolongation
of the global clotting tests,
APTT and PT,
and in its most extreme form,
disseminated intravascular
coagulation may occur.
0:51
Actually what we see
in the laboratory,
especially
in the routine laboratory,
is probably
the tip of the iceberg.
Under the surface, there is
a lot of coagulation activation
that may be clinically relevant,
present in patients
with severe infection and sepsis
and the associated
systemic
inflammatory states.
1:11
Disseminated
intravascular coagulation
is often seen
as a confusing clinical entity.
This is also reflected
by the various names
that can be found
for the condition in textbooks.
Are they surgical
or intensive care textbooks
or textbooks of hematology
and internal medicine?
But actually all these name
points to the same
clinical entity
that we nowadays call
disseminated
intravascular coagulation.
1:37
DIC has been with us
for centuries
and it's probably
the first description stems
from many, many years ago.
In the first
experimental setting
with what we would now
call experimental DIC
was described in 1834 in Paris,
when injection of brain material
into animals
resulted in a widespread
activation of coagulation,
resulting in clot formation
and also death of the animals.
