Disseminated Intravascular Coagulation (DIC) Overview



Increased Clotting and Consumption of Clotting Factors



Findings:

 • Bleeding

 • Recent history of trauma, sepsis, malignancy (Especially acute promyelocytic leukemia) or ABO incompatible blood transfusion

 • Thrombocytopenia

 • Prolonged PT/PTT

 • Low plasma fibrinogen

 • Elevated D-Dimer

 • Increased thrombin time

 • Reduced levels of factors VII, X, V and II

 • Reduced levels of antithrombin, protein C and S



Pathophysiology:

 • Process is simultaneous coagulation and fibrinolysis

 • Procoagulant Exposure → Tissue factor → Fibrinolysis → End organ damage



Clinical Findings:

 • Bleeding (64%)

 • Renal dysfunction (25%)

 • Hepatic dysfunction (19%)

 • Respiratory dysfunction (16%)

 • Shock (14%)

 • Thromboembolism (7%)

 • CNS involvement (2%)



Cutaneous Manifestations of DIC:

 • Petechiae

 • Purpura

 • Palpable variants of both

 • Acral cyanosis

 • Hemorrhagic bullae

 • Purpura fulminans

 • Subcutaneous dissecting hematoma

 • Bleeding from wound or venipuncture sites



Laboratory Findings in DIC:

 • Platelet count: ↓

 • Fibrinogen: ↓

 • PT/INR: ↑

 • PTT: ↑

 • D-Dimer: ↑

 • Peripheral smear: Schistocytes, helmet cells



DDX:

 • TMA’s (HUS/TTP/DITMA)

	- MAHA + Thrombocytopenia

	- Platelet rich microthrombi without significant fibrin clot formation or consumption coagulopathy

	- Thrombocytopenia

	- Normal coagulation studies

	- PBS: + Schistocytes

	- MAHA: TTP/HUS > DIC

 • Severe Liver Disease:

	- Impaired synthesis of coagulation factors

	- Reduction of pro/anticoagulants

	- Thrombocytopenia - bleeding or thrombosis (Hypersplenism and thrombopoietin deficiency)

 • HIT: Heparin-PF4 antibodies/SRA

	- + Thrombosis

	- + Bleeding



Treatment:

 • Treat primary cause

 • Correct coagulation abnormalities

	- PLT, FFP, Cryoprecipitate

	- PLT > 50,000

	- Fibrinogen > 150 (Cryoprecipitate to increase > 100mg/dL)

	- Heparin if presence of large thrombosis

	- Hg > 7

	- INR < 2.3

	- APTT < 1.5 x normal



Supportive Measures:

 • Hemodynamic/Ventilatory support

 • Aggressive hydration

 • RBC transfusion for bleeding



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