DIFFERENTIATED COAGULOGRAM. DISSEMINATED INTRAVASCULAR COAGULATION (DIC) SYNDROME
1. The topic studied actuality. In saliva there are many substances influencing on microcirculative (platelet-vascular) hemostasis, blood coagulation and fibrinolysis. These substances existence in saliva plays significant physiological role and also is directly important in pathological processes development in oral cavity and its organs.
These factors role is in following: saliva washing oral mucosa encourages local hemostasis. It is well-known that wounded surface on oral mucosa occurs every day during eating and possibility of blood vessels is quite big. But bleedings in oral cavity are stopped quickly due to active salivary procoagulants and, first of all, thromboplastin.
At the same time, oral mucosa high regenerative ability during small traumas under physiological conditions is provided mainly due to fibrinolytic agents in saliva. These agents help mucosa clearance from fibrin plicas and desquamated epitheliocytes.
During latest 209 years in literature question about tight interconnection and interrelation between hemostatic processes and other protective blood and tissular systems (antioxidant, immune, complement, non-specific resistance) is discussed. The same interrelations between mentioned reactions are also present in oral cavity both in saliva and in tissular level. In given substrates one can find free radicals, antioxidants, immunocompetent cells, non-specific defense factors. Their activity and level are changed in saliva and tissues at some pathological reactions.
For example, at stomatites, parodontitis, jaws fractures and other pathological processes in oral cavity saliva (and corresponding tissues) stimulating influence on microcirculative hemostasis state, blood coagulation and fibrinolysis. Saliva thrombocytoactive and coagulational features enforcement at different-origined inflammation processes in oral cavity encourages local hemostasis as he result of which fibrin is formed. Fibrin helps wounded surface repair. But this reaction must not have excessive character because increased fibrin formation can be unfavorable phenomenon which disturbs tissue inflamed locus feeding and encourages microflora growth in this locus (fibrin is a very favorable nutritive environment).
At the same time, fibrinolytic features increasing at this is of essential importance because it helps tissues clearance from different metabolism products and fibrin coating. Besides, saliva active fibrinolytic agents can encourage oral cavity tissues tolerance to hypoxy. Although, excessive fibrinolytic features increasing in saliva can play also negative role leading to premature fibrin removal (i.e in alveole of extracted tooth) and thus to slow reparation down. In the first inflammation days when hyperfibrinolysis takes place in saliva such reaction is essential for wound clearance from non-alive tissues and products of their decomposition. Then, when wound is clean and connective tissue granulation has begun excessive fibrinolysis can be unfavorable. Under such conditions we must inhibit fibrinolysis.
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According to literature data, at the biggest amount of pathological processes in oral cavity are accompanied by hypercoagulation. Such reaction is considered to be the signal about injure.
At excessive influencings (inflammations, tissues injures at woundings, traumas and others) in oral cavity one can determine anticoagulant hemostatic link weakening. As a result, reaction transmits to disseminated intravascular coagulation (DIC).
DIC – is the result of quantitative movements in hemostasis system which lead to the new state. Main region for all disorders development is microcirculatory vascular bed. Under one conditions this state has local, under the others – more generalized character. DIC-syndrome at salivary glands diseases, stomatites, mucosa injuries at jaws traumas, surgical influencings in this area and other processes development are more often of local character.
During tissues injure for example salivary glands its decomposition products come to the blood stream. It becomes key factor of DIC-syndrome development. Such a reaction in oral cavity has such course like at Artus’ or Sanarelli-Shwarzmann’s reaction. They are the most typical DIC-syndromes variants in dentistry.
Therapy: just-frozen plasma (blood coagulation factors source)+heparin (anticoagulants source)+symptomatic therapy.
Study aims:
To know: hemostasisdisorders at DIC-syndrome, tests set for DIC diagnostics.
To be able to: assess microcirculative and coagulation hemostasis state.
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