DIC

Question 1

What is DIC

Answer 1

Disseminated Intravascular Coagulation

Question 2

What is the pathology of DIC

Answer 2

Preceding trigger
(Includes trauma (burns), sepsis, mali8gnancy, shock, acute hepatic failure and acute pancreatitis)

Instigates mass systemic activation of coagulation cascade. This has two simultaneous effects:

1-widespread formation of microvascular thrombosis which reduce associated organ perfusion -> ischaemia and infarction
2. Spontaenous bleeds due to thrombocytopenia (coagulation factors are all spent) - (both primary and secondary haemostasis dysfunction)

Question 3

How can these triggers instigate DIC?

Answer 3

Tumor cells can produce procoagulant factors, which can trigger the activation of the coagulation system and promote clotting

Trauma can trigger DIC through the release of tissue factors, which can activate the coagulation system and promote clotting

Pregnancy-related complications can trigger DIC through the release of tissue factors and other procoagulant factor

Infection can trigger DIC through the release of pro-inflammatory cytokines

Question 4

How can DIC present

Answer 4

Consider the Signs and Symptoms of underlying pathology

Localized infarction of digits
Purapura fulminans - Skin necrosis
Bleeding -
Mucocutaneous bleeds - bruising, easy gi bleeds, petechiae, rash, epistaxis

Anatomical bleeds - haemorrhage

+/- Anaemia due micro-clot destruction of RBC

Question 5

DX DIC

Answer 5

Clotting screen:
Down - APTT/PT
Down - Bleeding time

Blood film- Schistocytes (broken rbc)
but not specific

D dimer UP

Question 6

If DIC shows both pro-coagulative and anti coagulative properties - which do you treat first?

Answer 6

First treat underlying cause
replace clotting factors
fibrinogen - cryoprecipitate
Platelets - Platlet transfusion

+ Prophylactic Heparin