Disseminated Intravascular Coagulation (DIC)

Disseminated Intravascular Coagulation (DIC)

David Ray Velez, MD

Table of Contents

Definition
Causes
Presentation
Diagnosis
Treatment

Definition

Definition: Pathologic Systemic Activation of Blood Coagulation and Fibrinolysis

Also Known As

  • “Consumption Coagulopathy”
  • “Defibrination Syndrome”

Stages

  • Stage 1: Overactive Activation of Clotting Processes
  • Stage 2: Uncontrolled Fibrinolysis and Bleeding Due to Depletion of Platelets and Clotting Factors

Causes

Always Secondary to an Underlying Cause

Causes

  • Sepsis – The Most Common Cause
  • Malignancy
    • Solid Tumors
    • Myeloproliferative Disorders
    • Leukemia
  • Trauma
  • Burns
  • Organ Damage
    • Severe Pancreatitis
    • Severe Liver Failure
  • Obstetric Complications
    • Amniotic Fluid Embolism
    • Placental Abruption
    • HELLP Syndrome
    • Preeclampsia and Eclampsia
    • Septic Abortion
  • Fat Embolism
  • Large Vascular Aneurysms
  • Drug Overdose
  • Toxins
  • ABO Incompatibility
  • Transplant Rejection

Presentation

Causes Both Bleeding and Thrombosis

Bleeding

  • The Most Common Clinical Manifestation
  • Bloody Oozing from Catheters or Drains
  • Bloody Oozing from Sites of Trauma or Surgery
  • Petechiae and Ecchymosis

Thrombosis

  • Thrombosis of Both Small and Large Vessels
  • Venous Thromboembolism (VTE)
  • Arterial Thrombosis – Most Common Cause of Digital Necrosis

Additional Complications

  • Renal Failure
  • Hepatic Dysfunction
  • Respiratory Failure
  • Shock
  • Death

Diagnosis

Diagnosis is Based on Both Clinical Findings and Labs in an Appropriate Setting

Associated Labs

  • PT: Prolonged
  • PTT: Prolonged
  • Platelets: Decreased
  • Fibrinogen: Decreased
  • Fibrin Split Products (D-Dimer): Elevated
  • Thrombin and Plasmin: Elevated

TEG

  • TEG is Nonspecific
  • Can Show a Hypercoagulable State: Decreased R Time and Increased MA
  • Can Show a Hypocoagulable State: Increased R Time and Decreased MA

Treatment

Treatment is Primarily Supportive with Management of the Underlying Cause

  • Abnormalities Generally Improve within a Few Days After Cause Relieved

Systemic Therapy

  • Systemic Therapy is Not Given Prophylactically
  • Bleeding May Be Treated with FFP or Platelet Transfusion as Indicated
    • TXA is Contraindicated (Blocking Fibrinolysis Increases VTE Risk)
  • Thromboembolism is Treated with Heparin Infusion