Hematology: Disseminated Intravascular Coagulation (DIC)

Definition

• Also Known As:
  • Consumption Coagulopathy
  • Defibrination Syndrome
• Definition: Pathologic Systemic Activation of Blood Coagulation & Fibrinolysis
• Always Secondary to Underlying Cause

Causes

• Sepsis – Most Common Cause
• Malignancy
• Trauma
• Obstetric Complications
• Fat Embolism
• Drug Overdose
• Transplant Rejection

Presentation

• Bleeding – Most Common Clinical Manifestation
  • Bloody Oozing from Catheters or Drains
  • Bloody Oozing from Sites of Trauma or Surgery
  • Petechiae/Ecchymosis
• Thrombosis – Both Small & Large Vessels
  • Venous Thromboembolism (VTE)
  • Arterial Thrombosis – Most Common Cause of Digital Necrosis
• Renal or Hepatic Dysfunction
• Respiratory Failure
• Shock or Death

Diagnosis

• Associated Labs:
  • PT: Prolonged
  • PTT: Prolonged
  • Platelets: Decreased
  • Fibrinogen: Decreased
  • Fibrin Split Products (D-Dimer): Elevated
  • Thrombin & Plasmin: Elevated
• Definitive Diagnosis:
  • Based on Both Clinical Findings & Labs in an Appropriate Setting

Treatment

• Primary Treatment: Treat Underlying Cause
  • Continue Supportive Cares as Indicated
  • Abnormalities Generally Improve within a Few Days After Cause Relieved
• Systemic Therapy:
  • Generally Not Given Prophylactically
  • Bleeding May Be Treated with Platelet Transfusions or FFP as Indicated
    • TXA is Contraindicated (Blocking Fibrinolysis Increases VTE Risk)
  • Thromboembolism Treated with Heparin Infusion