Why blood clotting is a vital important part of the bloodstream through platelets and how it works is what would we will review first to understand disseminated intra-vascular coagulopathy (DIC).  It is a vital important process of the platelets that make up part of our bloodstream cells that help prevent excessive bleeding or excessive hemorrhage.

In how clotting works is platelets, which is a type of blood cell, with plasma that is in our liguid part of blood work together to stop the bleeding by forming a clot over the injury (a bruise or cut in the skin) which stops the bleed.  Both veins and arteries transport our blood (both solids=cells) and the liguid (the plasma) that are read by out hematocrit and hemoglobin in a CBC=complete blood count which also tell the MD our reading of red/white blood cell counts with platelets.  Typically, your body will dissolve the clot after the injury has healed.  However, there are times clots form on the inside of our vessels (there are variables of why this would happen that are discussed later in this topic).  These situations can be dangerous and put the pt at risk for problems.  This needs to be diagnosed and given appropriate treatment by your doctor or MD specialist.

Clots can occur in our veins or arteries and can occur is various areas causing

1-DVT=Deep Vein Thrombosis

DVT commonly in our large veins that are commonly found in our lower extremities and less likely in our upper extremities or pelvic region or other areas where there are large veins. The problem (one the clot is wedged and stuck against the vessel) with this the clot blocks off circulation to the area below the clot to a percentage low to 100% blockage.  This is where in the skin there is pain to necrosis below the clot area (for this to happen it takes numerous hours-pain to days-changes in skin color or week or more-necrosis depending on the blockage).   The greater the blockage is the quicker the symptoms arise no matter where the clot is.  It is estimated that each year DVT affects as many as 900,000 people in the United States by the American Heart Association and kills up to 100,000 by the Centers for Control and Prevention (CDC).

-Paget-Schroetter Syndrome (PSS) – It’s a rare kind of DVT that typically happens to a young, healthy person who plays sports that use the upper arms a lot, like swimming and baseball. The vein can get squeezed by the muscles around it. This pressure, along with repeated movements, can cause a clot in your shoulder. Symptoms like swelling, chest pain, and a blue color to your skin may come on suddenly. PSS can be serious if it’s not treated right away.

2-Atrial Fibrillation

Another area where blood clotting can occur is in the heart.   We see commercials all the time about atrial fibrillation=irregular rhythm with the heart beat.  In the commercial its usual an add for a med called a anticoagulant that does the opposite of what platelets do=clotting to prevent this problem from happening in the heart which indirectly prevents clotting in all vessels as well.  The med thins the blood.   The major problem with this diagnosis, atrial fibrillation without being on a anticoagulant, is blood can pool in the heart causing a clot to form in the heart and at some point, especially when the rhythm is rapid and more irregular that usual=RVR-rapid ventricular rate over 100 beats per minute and usually over 130 to over 150, the clot can break off.

3-Heart Attack

Know this, more often than not, a broken piece of plaque within the arteries triggers the formation of a blood clot. This blood clot is the reason for a heart attack. As the blood clot potentially restricts the flow of blood and oxygen to the heart, depending on the severity, the heart attack can cause sudden death.

There are other areas where blood can form clots but not as common in what was mentioned above. Blood clots can arise anywhere in your body. They develop when blood thickens and clumps together. When a clot forms in a deep vein in the body, it’s called deep vein thrombosis. Deep vein blood clots typically occur in the lower leg or thigh.

The biggest consequence of any blood clot no matter where it is it can break off in time for many especially with a DVT.   Than there is  atrial fibrillation patients not on a anti-coagulant or anti-platelet like Coumadin, Eliquis, heparin, and lovenox to Plavix, Brilinta, Ticlid and Integrilin with other medications (listed commonly used in my nursing career) it puts them at risk for a clot to break off in the heart due to pooling blood causing a clot formation and when it breaks off it could go the the lungs causing pulmonary embolus or the brain a stroke.

For understanding the meaning lets review; Deep vein thrombosis (DVT) is a condition in which a blood clot develops in the deep veins, usually in the lower extremities. A pulmonary embolism (PE) occurs when a part of the DVT clot breaks off and travels to the lungs, which can be life-threatening. Venous thromboembolism (VTE) refers to DVT, PE, or both.

When a clot breaks off it floats now in the bloodstream and can in time make it back to the heart putting the pt at risk for a heart attack if it didn’t get stuck elsewhere, like going to the lungs putting the pt at risk for a pulmonary embolism or now in circulation making it to the brain putting the pt at risk for a stroke!  Clots are common in making the strokes in what we call ischemic stroke and another name “silent stroke”.   Silent strokes are much more common than strokes that cause classic symptoms such as face drooping, arm weakness and speech difficulty and affect nearly 800,000 Americans each year. According to the statement, one in four people over 80 have one or more silent strokes.

SARS, MERS, and Corona Viruses  are all caused by some CORONA VIRUS!

Through the National Library of Medicine they state:

“In the 21^st century, we have seen a total of three outbreaks by members of the coronavirus family. Although the first two outbreaks did not result in a pandemic, the third and the latest outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) culminated in a pandemic. This pandemic has been extremely significant on a social and international level. As these viruses belong to the same family, they are closely related. Despite their numerous similarities, they have slight distinctions that render them distinct from one another!”

Both COVID-19 and SARS are caused by coronaviruses. The virus that causes SARS is known as SARS-CoV, while the virus that causes COVID-19 is known as SARS-CoV-2.  So what does this mean?  A severe respiratory illness that is caused by a coronavirus (Severe acute respiratory syndrome-related virus of the genus Betacoronavirus) 

SARS is caused by Betacoronavirus that is one of four genera of coronaviruses. Member viruses are enveloped, positive-strand RNA viruses that infect mammals, including humans.  The first generation of covid.

COVID-19, which is caused by the 2019 coronavirus, has been dominate news starting 2019. However, you may have first become familiar with the term coronavirus during the severe acute respiratory syndrome (SARS) outbreak in 2003.

Both COVID-19 and SARS are caused by coronaviruses. The virus that causes SARS is known as SARS-CoV, while the virus that causes COVID-19 is known as SARS-CoV-2. There are also other types of human coronaviruses.

Despite similar names, there are several differences between the coronaviruses that cause COVID-19 and SARS.

Copyright © 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.”

Their references:

“Severe acute respiratory syndrome (SARS) is a contagious and sometimes fatal respiratory illness. severe acute respiratory syndrome (SARS) first appeared in China in November 2002. Within a few months, SARS spread worldwide, carried by unsuspecting travelers.

SARS showed how quickly infection can spread in a highly mobile and interconnected world. On the other hand, a collaborative international effort allowed health experts to quickly contain the spread of the disease.

SARS is caused by a strain of coronavirus, the same family of viruses that causes the common cold.

Coronaviruses can, however, cause severe disease in animals, and that’s why scientists suspected that the SARS virus might have crossed from animals to humans. It now seems likely that that the virus evolved from one or more animal viruses into a new strain.”

MAYO Clinic (https://www.mayoclinic.org/diseases-conditions/sars/symptoms-causes/syc-20351765)

  4 days ago

World Health Organization on this disease SARS coronavirus:

Severe acute respiratory syndrome (SARS) is a viral respiratory disease caused by a SARS-associated coronavirus. It was first identified at the end of February 2003 during an outbreak that emerged in China and spread to 4 other countries.

The virus identified in 2003. SARS-CoV is thought to be an animal virus from an as-yet-uncertain animal reservoir, perhaps bats, that spread to other animals (civet cats) and first infected humans in the Guangdong province of southern China in 2002.

Transmission

An epidemic of SARS affected 26 countries and resulted in more than 8000 cases in 2003. Since then, a small number of cases have occurred as a result of laboratory accidents or, possibly, through animal-to-human transmission (Guangdong, China).

Transmission of SARS-CoV is primarily from person to person. It appears to have occurred mainly during the second week of illness, which corresponds to the peak of virus excretion in respiratory secretions and stool, and when cases with severe disease start to deteriorate clinically. Most cases of human-to-human transmission occurred in the health care setting, in the absence of adequate infection control precautions. Implementation of appropriate infection control practices brought the global outbreak to an end.

Nature of the disease

Symptoms are influenza-like and include fever, malaise, myalgia, headache, diarrhoea, and shivering (rigors). No individual symptom or cluster of symptoms has proved to be specific for a diagnosis of SARS. Although fever is the most frequently reported symptom, it is sometimes absent on initial measurement, especially in elderly and immunosuppressed patients.

Cough (initially dry), shortness of breath, and diarrhoea are present in the first and/or second week of illness. Severe cases often evolve rapidly, progressing to respiratory distress and requiring intensive care.

Geographical distribution

The distribution is based on the 2002–2003 epidemic. The disease appeared in November 2002 in the Guangdong province of southern China. This area is considered as a potential zone of re-emergence of SARS-CoV.

Other countries/areas in which chains of human-to-human transmission occurred after early importation of cases were Toronto in Canada, Hong Kong Special Administrative Region of China, Chinese Taipei, Singapore, and Hanoi in Viet Nam.

Risk for travellers

Currently, no areas of the world are reporting transmission of SARS. Since the end of the global epidemic in July 2003, SARS has reappeared four times – three times from laboratory accidents (Singapore and Chinese Taipei), and once in southern China where the source of infection remains undetermined although there is circumstantial evidence of animal-to-human transmission.

Should SARS re-emerge in epidemic form, WHO will provide guidance on the risk of travel to affected areas. Travellers should stay informed about current travel recommendations. However, even during the height of the 2003 epidemic, the overall risk of SARS-CoV transmission to travellers was low.

Prophylaxis

None. Experimental vaccines are under development.

The National Institute of Health (NIH) states:

The virus that causes coronavirus disease 2019 (COVID-19) is stable for several hours to days in aerosols and on surfaces, according to a new study from National Institutes of Health, CDC, UCLA and Princeton University scientists in The New England Journal of Medicine. The scientists found that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detectable in aerosols for up to three hours, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel. The results provide key information about the stability of SARS-CoV-2, which causes COVID-19 disease, and suggests that people may acquire the virus through the air and after touching contaminated objects. The study information was widely shared during the past two weeks after the researchers placed the contents on a preprint server to quickly share their data with colleagues.

The NIH scientists, from the National Institute of Allergy and Infectious Diseases’ Montana facility at Rocky Mountain Laboratories, compared how the environment affects SARS-CoV-2 and SARS-CoV-1, which causes SARS. SARS-CoV-1, like its successor now circulating across the globe, emerged from China and infected more than 8,000 people in 2002 and 2003. SARS-CoV-1 was eradicated by intensive contact tracing and case isolation measures and no cases have been detected since 2004. SARS-CoV-1 is the human coronavirus most closely related to SARS-CoV-2. In the stability study the two viruses behaved similarly, which unfortunately fails to explain why COVID-19 has become a much larger outbreak.

The NIH study attempted to mimic virus being deposited from an infected person onto everyday surfaces in a household or hospital setting, such as through coughing or touching objects. The scientists then investigated how long the virus remained infectious on these surfaces.

The scientists highlighted additional observations from their study:

• If the viability of the two coronaviruses is similar, why is SARS-CoV-2 resulting in more cases? Emerging evidence suggests that people infected with SARS-CoV-2 might be spreading virus without recognizing, or prior to recognizing, symptoms. This would make disease control measures that were effective against SARS-CoV-1 less effective against its successor.
• In contrast to SARS-CoV-1, most secondary cases of virus transmission of SARS-CoV-2 appear to be occurring in community settings rather than healthcare settings.  However, healthcare settings are also vulnerable to the introduction and spread of SARS-CoV-2, and the stability of SARS-CoV-2 in aerosols and on surfaces likely contributes to transmission of the virus in healthcare settings.

The findings affirm the guidance from public health professionals to use precautions similar to those for influenza and other respiratory viruses to prevent the spread of SARS-CoV-2:

• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose, and mouth.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

“Refreshing sleep is critically important for staying healthy. As with diet and exercise, sleep is crucial to physical, emotional, and mental health. A survey conducted by the Better Sleep Council found nearly 2 out of 3 respondents reported impaired sleep due to stress. One third of Americans experience poor sleep at least one night per week, and 16% are diagnosed with stress-induced insomnia. Respondents stated their productivity at home and in the workplace was impacted by sleep problems, as demonstrated in poor recall for details (30%), decreased accuracy and quality of work (30%), and impaired decision making (31%). The Better Sleep Council also estimated $150 billion in lost productivity and absenteeism results from poor sleep.

The consequences of inadequate sleep include reduced concentration, mood swings, irritability, stress, and a weakened immune system. The release of stress hormones can also make it harder to sleep, causing an unhealthy sleep cycle. Sleep deficits have been associated with high blood pressure, weight gain, diabetes, and a decreased tolerance of chronic pain. In severe cases, poor sleep may be linked to serious sleep disorders including narcolepsy, insomnia, restless leg syndrome, and sleep apnea.”

Medical West (https://www.medicalwesthospital.org/may-is-better-sleep-month.php)

Risk factors”

There are only a few known risk factors for narcolepsy, including:

• Age. Narcolepsy typically begins between ages 10 and 30.
• Family history. Your risk of narcolepsy is 20 to 40 times higher if you have a close family member who has it.

Complications:

• Public misconception of the condition. Narcolepsy can cause problems at work or in your personal life. Your performance may suffer at school or work. Others might see people with narcolepsy as lazy or lethargic.
• Effects on intimate relationships. Intense feelings, such as anger or joy, can trigger cataplexy. This can cause people with narcolepsy to withdraw from emotional interactions.
• Physical harm. Falling asleep suddenly may result in injury. You’re at increased risk of a car accident if you fall asleep while driving. Your risk of cuts and burns is greater if you fall asleep while cooking.
• Obesity. People with narcolepsy are more likely to be overweight. Sometimes weight rapidly increases when sleepiness symptoms start.

How your MD comes to this Diagnosis:

Your health care provider may suspect narcolepsy based on your symptoms of excessive daytime sleepiness and sudden loss of muscle tone, known as cataplexy. Your provider will likely refer you to a sleep specialist. Formal diagnosis requires staying overnight at a sleep center for an in-depth sleep analysis.

A sleep specialist will likely diagnose narcolepsy and determine how severe it is based on:

• Your sleep history. A detailed sleep history can help with a diagnosis. You’ll likely fill out the Epworth Sleepiness Scale. The scale uses short questions to measure your degree of sleepiness. You’ll answer how likely it is that you would fall asleep in certain times, such as sitting down after lunch.
• Your sleep records. You may be asked to write down your sleep pattern for a week or two. This allows your provider to compare how your sleep pattern may relate to how alert you feel.Your health care provider also may ask you to wear an actigraph. This device is worn like a watch. It measures periods of activity and rest. It provides an indirect measure of how and when you sleep.
• A sleep study, known as polysomnography. This test measures signals during sleep using flat metal discs called electrodes placed on your scalp. For this test, you must spend a night at a medical facility. The test measures your brain waves, heart rate and breathing. It also records your leg and eye movements.
• Multiple sleep latency test. This test measures how long it takes you to fall asleep during the day. You’ll be asked to take four or five naps at a sleep center. Each nap needs to be two hours apart. Specialists will observe your sleep patterns. People who have narcolepsy fall asleep easily and enter into rapid eye movement (REM) sleep quickly.
• Genetic tests and a lumbar puncture, known as a spinal tap. Occasionally, a genetic test may be performed to see if you’re at risk of type 1 narcolepsy. If so, your sleep specialist may recommend a lumbar puncture to check the level of hypocretin in your spinal fluid. This test is only done in specialized centers.

These tests also can help rule out other possible causes of your symptoms. Excessive daytime sleepiness could also be caused by sleep deprivation, the use of sedating medicines and sleep apnea.

“Narcolepsy is a chronic sleep disorder, or dyssomnia. The condition is characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as while at work or at school.

“In a recent systematic literature review and questionnaire study published in Sleep Medicine, findings showed that opioids, specifically oxycodone and codeine, were associated with improvements in self-reported narcolepsy symptoms such as disturbed nocturnal sleep and excessive daytime sleepiness. Overall, these findings suggest that opioid use could provide symptom relief in patients with narcolepsy type 1″;  stated by NeurologyLive (https://www.neurologylive.com)

THEIR REFERENCES WERE:
1. Gool JK, van Heese EM, Schinkelshoek MS, et al. The therapeutic potential of opioids in narcolepsy type 1: A systematic literature review and questionnaire study. Sleep Med. 2023;109:118-127. doi:10.1016/j.sleep.2023.06.008
2. Thannickal TC, John J, Shan L, et al. Opiates increase the number of hypocretin-producing cells in human and mouse brain and reverse cataplexy in a mouse model of narcolepsy. Sci Transl Med. 2018;10(447):eaao4953. doi:10.1126/scitranslmed.aao4953

UCLA health states;

“Researchers have found both humans addicted to heroin and mice addicted to morphine develop higher numbers of hypocretin producing neurons. Morphine causes hypocretin neurons to increase their anatomical connections to pleasure related brain regions.

The annual US rate of opioid overdose deaths now exceeds 80,000, greater than the annual rates of automobile or gun deaths,” said the study’s senior author, Dr. Jerome Siegel of UCLA Health’s Jane & Terry Semel Institute for Neuroscience and Human Behavior, the UCLA Brain Research Institute and U.S. Department of Veterans Affairs.

New research led by UCLA Health has found a drug that treats insomnia works to prevent the addictive effects of the narcotic addiction effect by Morphine and other opiods.  Hypocretin, also called orexin, is a peptide that is linked to mood, with hypocretin release in humans being maximal during pleasurable activities and minimal during pain or sadness. The loss of hypocretin neurons is the cause of narcolepsy, which is thought to be an autoimmune disease”

Narcolepsy is a sleep disorder that makes people very drowsy during the day. People with narcolepsy find it hard to stay awake for long periods of time. They fall asleep suddenly. This can cause serious problems in their daily routine.

Sometimes narcolepsy also causes a sudden loss of muscle tone, known as cataplexy (KAT-uh-plek-see). This can be triggered by strong emotion, especially laughter. Narcolepsy is divided into two types. Most people with type 1 narcolepsy have cataplexy. Most people who don’t have cataplexy have type 2 narcolepsy.

Narcolepsy is a life-long condition for which there’s no cure. However, medicines and lifestyle changes can help manage the symptoms. Support from others — family, friends, employers and teachers — can help people cope with the disorder.

Symptoms of this disorder:

The symptoms of narcolepsy may get worse during the first few years of the disorder. Then they continue for life. They include:

• Excessive daytime sleepiness. People with narcolepsy fall asleep without warning. It can happen anywhere and at any time. It may happen when you’re bored or during a task. For example, you may be working or talking with friends and suddenly fall asleep. It can be especially dangerous if you fall asleep while driving. You might fall asleep for only a few minutes or up to a half-hour. After waking, you’ll often feel refreshed but you’ll get sleepy again.You also may experience a decrease in how alert and focused you feel during the day. Daytime sleepiness often is the first symptom to appear. Feeling sleepy makes it hard to focus and function.Some people with narcolepsy continue doing a task when they fall asleep briefly. For example, you may fall asleep while writing, typing or driving. You might continue to perform that task while asleep. When you awaken, you can’t remember what you did, and you probably didn’t do it well.
• Sudden loss of muscle tone. This condition is called cataplexy. It can cause slurred speech or complete weakness of most muscles. Symptoms may last up to a few minutes.Cataplexy can’t be controlled. It’s triggered by intense emotions. Often the emotions that cause cataplexy are positive. Laughter or excitement may cause the symptoms. But sometimes fear, surprise or anger can cause the loss of muscle tone. For example, when you laugh, your head may drop without your control. Or your knees may suddenly lose strength, causing you to fall.Some people with narcolepsy experience only one or two episodes of cataplexy a year. Others have several episodes a day. Not everyone with narcolepsy has these symptoms.
• Sleep paralysis. People with narcolepsy often experience sleep paralysis. During sleep paralysis, you can’t move or speak while falling asleep or upon waking. It’s usually brief — lasting a few seconds or minutes. But it can be scary. You may be aware of it happening and can recall it afterward.
  

  Not everyone with sleep paralysis has narcolepsy.

• Hallucinations. Sometimes people see things that aren’t there during sleep paralysis. Hallucinations also may happen in bed without sleep paralysis. These are called hypnagogic hallucinations if they happen as you fall asleep. They’re called hypnopompic hallucinations if they happen upon waking. For example, you might feel as if there is a stranger in your bedroom. These hallucinations may be vivid and frightening because you may not be fully asleep when you begin dreaming.
• Changes in rapid eye movement (REM) sleep. REM sleep is when most dreaming happens. Typically, people enter REM sleep 60 to 90 minutes after falling asleep. But people with narcolepsy often move more quickly to REM sleep. They tend to enter REM sleep within 15 minutes of falling asleep. REM sleep also can happen at any time of the day.

Other characteristics

People with narcolepsy may have other sleep disorders. They might have obstructive sleep apnea, in which breathing starts and stops during the night. Or they may act out their dreams, known as REM sleep behavior disorder. Or they may have trouble falling asleep or staying asleep, called insomnia.

The Possible Causes:

The exact cause of narcolepsy is unknown. People with type 1 narcolepsy have low levels of hypocretin (hi-poe-KREE-tin), also called orexin. Hypocretin is a chemical in the brain that helps control being awake and when you enter REM sleep.

Hypocretin levels are low in people who experience cataplexy. Exactly what causes the loss of hypocretin-producing cells in the brain isn’t known. But experts suspect it’s due to an autoimmune reaction. An autoimmune reaction is when the body’s immune system destroys its own cells.

It’s also likely that genetics plays a role in narcolepsy. But the risk of a parent passing this disorder to a child is very low — only about 1% to 2%.

“Hemophilia is a rare disorder in which the blood doesn’t clot in the typical way because it doesn’t have enough blood-clotting proteins (clotting factors). 

The main treatment for severe hemophilia involves replacing the clotting factor you need through a tube in a vein.

This replacement therapy can be given to treat a bleeding episode in progress. It can also be given on a regular schedule at home to help prevent bleeding episodes. Some people receive continuous replacement therapy.

Replacement clotting factor can be made from donated blood. Similar products, called recombinant clotting factors, are made in a laboratory, not from human blood.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/hemophilia/diagnosis-treatment/drc-20373333)