DIC

Question 1

What is disseminated intravascular coagulation

(DIC) and how does it occur?

Answer 1

DIC is a condition that arises when the coagulation system
becomes activated over such as widespread area that small
clots begin to occlude the small peripheral blood vessels
throughout the body. Excessive fibrinolysis to compensate for
the consumption of coagulation factors during the clotting
process also contributes to the progression of DIC. It commonly
occurs due to massive trauma or the presence of a large
amount of dying tissue that releases tissue factor into the
bloodstream.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 459.

Question 2

Why does DIC often result in bleeding?

Answer 2

Because the coagulation pathway is activated throughout the
body on a massive scale, the clotting factors can become
exhausted. As more thromboses form, the coagulation factors
become so diminished that spontaneous bleeding can occur in
other parts of the body.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 424.

Question 3

What are some known causes of DIC?

Answer 3

Sepsis, leukemia, cancer, and trauma. Placenta previa,
abruption, amniotic fluid embolism, or the presence of a dead
fetus late in pregnancy can also result in DIC. Prolonged
surgery and surgery for certain procedures such as
prostatectomy for carcinoma, liver transplantation, and coronary
bypass surgery are associated with significant bleeding
abnormalities.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 897.

Question 4

How can DIC lead to organ failure?

Answer 4

The widespread bleeding and thrombosis can cut off the blood
supply to tissues and organs, resulting in ischemia.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 894.

Question 5

What laboratory values are decreased in patients

with DIC?

Answer 5

Fibrinogen, platelet count, antithrombin level, factor V, and
factor VIII will all be decreased in patients with DIC.
Ferri FF. Ferri’s Best Test. 2nd ed. Philadelphia, PA: Mosby-
Elsevier; 2010: 222.
Lee CY. Manual of Anesthesiology. Singapore: McGraw-Hill;
2006: 274.

Question 6

What laboratory values are increased in patients with

DIC?

Answer 6

The PT, PTT, thromboplastin time, D-dimer, and fibrin
degradation products are all elevated in patients with acute DIC.
Ferri FF. Ferri’s Best Test. 2nd ed. Philadelphia, PA: Mosby-
Elsevier; 2010: 222.

Question 7

How is sepsis related to DIC?

Answer 7

Endotoxins released from the bacteria can activate the
coagulation pathway. The microthromboses that form can
decrease the oxygen supply to the tissues and exacerbate
shock. DIC is one of the reasons that the mortality rate for
septic shock is as high as 85%. Although DIC may occur in
relation to gram-positive or even viral or fungal infections, it is
most strongly associated with gram-negative sepsis.
Guyton AC, & Hall, JE. Textbook of Medical Physiology. 12th
ed. Philadelphia: Saunders; 2011: 459.