14. DIC

Question 1

what occurs in DIC?

Answer 1

• Massive activation of coagulation that overwhelms control mechanisms –> thrombosis in microvasculature –> ischemia +microangiopathic hemolytic anemia
• acute consumption of coagulation factors and platelets + excessive fibrinolysis –> bleeding

Question 2

what occurs in chronic (compensated) DIC?

Answer 2

blood is exposed to smaller amounts of procoagulant substances

coagulation factors and platelets are consumed but production is able to compensate, and the liver is able to clear FDP’s

thrombosis predominates over bleeding

Question 3

most common causes of DIC

Answer 3

• Sepsis
• Malignancies
• Obstetric complication (abruptio placenta)
• Trauma

Question 4

clinical manifestations of DIC

Answer 4

Acute- shock, oozing from venipuncture sites, petechiae and ecchymoses , severe hemorrhage from the GI, lung, CNS

chronic- bleeding symptoms are discrete, restricted to the skin

Question 5

how to differentiate between DIC and severe liver disease?

Answer 5

lab abnormalities don’t change rapidly

factor VIII levels are normal (endothelial cells)

Question 6

how to differentiate between DIC and TTP?

Answer 6

Clinical presentation is similar

but PT and PTT are normal

Question 7

diagnosis of DIC

Answer 7

clinical+ lab:
↑ PT, ↑ PTT, ↓ fibrinogen, ↓ AT-III, FDP/D-dimer, ↓ PLT
↑ LDH, ↓ haptoglobin, schistocytes

chronic: + FDP/D- dimer, PLT variable, other labs are normal

Question 8

management of DIC

Answer 8

elimination of the underlying cause
supportive treatment:
-FFP, cryoprecipitate, PLT’s/ RBC’s transfusions
-Hemodynamic/ ventilatory support