KOAGULASI INTRAVASKULAR DISEMINATA
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PENGERTIAN Koagulasi intravaskular diseminata adalah aktivasi sistem koagulasi dan fibrinolisis secara berlebihan dan terjadi pada waktu yang bersamaan
DIAGNOSIS Klinis: Gejala-gejala umum seperti demam, hipotensi, asidosis, hipoksia, proteinuria Tanda-tanda perdarahan (petekie, purpura, ekimosis, hematoma, hematemesis-melena, hematuria,
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KID merupakan akibat dari kausa primer yang lain: Bida Bi dang ng obs obstetri etri (emb (embol olii ca cair iran an amni amnio on, kem kemat atia ian n janin intra-uterin, abortus, septik) Bida Bi dang ng hema hemattol olo ogi (rea reaksi ksi tran trans sfusi fusi,, hem hemol olis isis is berat, leukimia Infek nfeks si (se sep ptike tikemi mia, a, gram gram nega negati tif, f, gra gram pos osit itif if,, virus HIV, hepatitis, dengue, parasit malaria)
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Pemeriksaan penunjang: Pemeriksaan Kompensasi Hiperkompensasi Dekompensasi Trombosit PTT PT Fibrinogen D Dimer
N N N N +/↑
N N/↑ N/↑ N/↑ +/↑
↓ ↑ ↑ ↓ ++/↑ ↑
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DIAGNOSIS BANDING Fibrinolisis primer, penyakit hati berat, pseudo KID
PEMERIKSAAN PENUNJANG Laboratorium : DPL, hemostasis lengkap (PT, aPTT, fibrinogen, d-dimer)
TERAPI
Suportif Memperbaiki dan menstabilkan hemodinamik
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• •
Memperbaiki dan menstabilkan keseimbangan asam basa Memperbaiki dan menstabilkan keseimbangan
elektrolit Mengobati penyakit primer Menghambat proses patologis Antikoagulan Heparin intravena bolus tiap 6 jam dosis 5000 IU, evaluasi aPTT dengan target 1,5-2,5 x kontrol pada
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aPTT 1,5-2,5 x kontrol, dosis heparin tetap aPTT >2,5 x kontrol, evaluasi APTT pada jam keempat, bila: aPTT <1,5 x kontrol, heparin dinaikkan menjadi 7500 U aPTT >2,5 x kontrol, heparin dikurangi
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PROGNOSIS Malam
WEWENANG
RS Pendidikan : Dokter Spesialis Penyakit Dalam dan
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REFERENSI 2.
Tambunan, KL. Koagulasi intravascular diseminata. Dalam: Suyono, S. Waspadji, S. Lesmana, L. Alwi, I. Setiati, S. Sundaru, H.dkk. Buku Ajar Ilmu Penyakit Dalam. Jilid II. Edisi III. Jakarta: Balai
