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La CIVD ou Coagulation IntraVasculaire Disséminée (ou encore syndrome de défibrination ou coagulopathie de consommation) est un syndrome hémorragique caractérisé par la disparition du fibrinogène du sang circulant.
L'apparition soudaine de facteurs d'activation de la thrombine provoque la formation de dépots de fibrine et l'oblitération thrombotique des petits vaisseaux. Cette réaction consomme le fibrinogène, les facteurs V et VIII et les plaquettes. Le sang devient donc incoagulable et des hémorragies surviennent. Survient ensuite une phase réactionnelle avec héparinémie endogène et fibrinolyse.
Ce syndrome peut être contemporain d'un accouchement ou complication d'une pathologie de la grossesse (ex: pré-éclampsie, HELLP syndrome, etc), au cours d'une intervention de chirurgie thoracique (ex: cardiaque avec circulation extra-corporelle) ou prostatique, une septicémie, un choc, certaines maladies du sang (ex: leucémie aigue myéloïde), un cancer généralisé, une cirrhose, une intoxication, etc ...
Sa gravité dépend de l'importance des hémorragies et de l'ischémie résultant des thromboses que subissent les organes (reins, foie).
Au niveau du bilan biologique et hématologique, on observe un déficit en facteur de coagulation (fibrinogène, facteurs II, V et VIII), une thrombopénie et un taux élevé de D-dimères.
La prise en charge consiste en l'administration d'héparine, remplacée au stade ultime de l'hémorragie par des inhibiteurs de la fibrinolyse.
Source : encyclopédie wikipedia
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