DIC

Question 1

What are some precipitants of DIC?

Answer 1

Trauma

Sepsis

Malignancy

Severe transfusion reaction

Obstetric complication

Severe liver failure

Toxic reaction - envenomation, blood transfusion

Question 2

What are the four pathophysiological mechanisms of DIC?

Answer 2

TF-mediated thrombin generation

Dysfunction of physiologic anti-coagulation mechanisms

Impaired fibrin removal due to dysfunction of fibrinolytic pathways

Inflammatory activation

Question 3

How does DIC present typically?

Answer 3

Symptoms of the precipitating cause

Bleeding - particularly at 3 unrelated sites

Petechiae and ecchymosis

Renal/hepatic/respiratory dysfunction

Shock

Question 4

How can DIC be Ix?

Answer 4

Platelet count

APTT

Clotting factors

D-dimer

Question 5

How is DIC treated?

Answer 5

Treat underlying cause

Assure haemodynamic stability

Replace platelets and clotting factors or anti-coagulate with heparin depending on what is required

Question 6

What is commonly found on Ix for DIC?

Answer 6

Thrombocytopenia

Elevated APTT

Fibrin products

Elevated D-dimer

Schistocytes on blood film

Question 7

What is DIC?

Answer 7

Disseminated intravascular coagulation

Systemic activation of coagulation that leads to deposition of fibrin and thrombosis of microvasculature, contributing to multiple organ dysfunction syndrome. Consumption of platelets and clotting protein can trigger subsequent bleeding