Zusammenfassung
Abwehrsystem und Blutgerinnung sind eng verknüpfte und interagierende Systeme, die für die Integrität eines Organismus von entscheidender Bedeutung sind. Komplexe Mechanismen regulieren die Intensität einer Antwort auf eindringende Pathogene oder andere potentiell gefährliche Situationen. Normalerweise ist so eine Reaktion zeitlich limitiert und auf den Ort der Verletzung beschränkt. Manchmal jedoch erfolgt die systemische Antwort überschießend und unangepasst und führt zur Schädigung des Organismus anstatt zur Heilung. Abhängig vom genetischen Repertoire des Organismus, von seiner derzeitigen Immunkompetenz und der Art des Auslösers verursacht die systemische Antwort das klinische Bild einer Sepsis (in ihren verschiedenen Stadien). Die septische Organfunktionsstörung wird dabei von einer generalisierten Fibrinablagerung in der Mikrozirkulation verursacht, die aus überschießender Gerinnungsaktivierung, insuffizienten Antikoagulantien und gehemmter Fibrinolyse entsteht. Dieser Artikel beschreibt die zugrundeliegenden pathophysiologischen Mechanismen und stellt www.SepDIC.eu vor, eine Internetplattform zur Sepsis und der damit assoziierten Koagulopathie.
Summary
Host defense and blood coagulation are tightly connected and interacting systems, necessary for the integrity of an organism. Complex mechanisms regulate the intensity of a host response to invading pathogens or other potentially dangerous situations. Under regular conditions, this response is limited in time and located to the site of injury. Sometimes, however, systemic host response is overwhelming and disproportional and causes damage, not cure. Dependent on the genetical predisposition of the host, its current immunocompetence, or the type of injury, the reaction leads to the clinical picture of the different degrees of sepsis. Septic organ dysfunction is caused by intravascular fibrin deposition as a result of coagulation activation, anticoagulant breakdown, and shut down of fibrinolysis. This article describes the major pathophysiologic reactions in these situations and presents www.SepDIC.eu, an online tool on sepsis and associated coagulopathy.
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Knoebl, P. Blood coagulation disorders in septic patients. Wien Med Wochenschr 160, 129–138 (2010). https://doi.org/10.1007/s10354-009-0738-9
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DOI: https://doi.org/10.1007/s10354-009-0738-9