Disseminated Intravascular Coagulation Flashcards
Define Disseminated Intravascular Coagulation
Acquired syndrome characterised by activation of coagulation pathways and depletion of platelets and coagulation factors.
What are the types of Disseminated Intravascular Coagulation
Acute overt form: bleeding and depletion of platelets and clotting factors
Chronic non-overt form: thromboembolism is accompanied by generalised activation of the coagulation system
What are the causes of Disseminated Intravascular Coagulation
Sepsis/infection particularly gram -ve
Major trauma and burns
Malignancies: AML, metastatic mucin-secreting adenocarcinoma
Obstetric: amniotic fluid embolism, eclampsia, placental abruption
Severe organ destruction or failure: pancreatitis, hepatic failure
Vascular
Severe toxic or immunological reaction: blood transfusion reaction, haemolytic reaction, transplant rejection, snake bite
What are the symptoms and signs of Disseminated Intravascular Coagulation
Critically ill - signs of severe sepsis or shock or extensive tissue damage
Bleeding: petechiae, ecchymoses, haematuria, epistaxis, mucosal bleeding
Haemolytic: jaundice, conjunctival pallor
Non-blanching purpuric rash
Conjunctival haemorrhage
Dyspnoea
Delirium, coma
What is the difference between the signs of haemorrhagic vs thrombotic Disseminated Intravascular Coagulation
Bleeding venepuncture sites, indwelling catheters, drain sites, surgical wounds
Spontaneous or minimal trauma-related generalised ecchymoses
Large, bullous haemorrhagic skin lesions on previous viral exanthematous sites
Mucosal bleeding from gingiva, gastrointestinal or renal tracts
Thrombophlebitis
Renal impairment in the absence of other explanations
Fluctuating central nervous system disturbances like confusion, and seizures (microcirculatory ischaemia)
Respiratory distress syndrome with no obvious explanation
Dermal infarcts and skin necrosis
Greyish discolouration of finger tips, toes or ear lobes, which has been termed ‘acral cyanosis’; usually seen in extreme cases
What investigations should be done for Disseminated Intravascular Coagulation
Septic screen (urinalysis, NPA, blood cultures, blood gas, CXR)
Bloods:
- clotting (APTT prolonged, PT prolonged, protein C/S and antithrombin reduced
- Fibrinogen and fibrin degradation productions: fibrinogen reduced, products elevated
- FBC: thrombocytopenia, macrocytic anaemia
- D-dimer: raised
- Blood film: schistocytes
- LFTs
- U&Es
What is the management for Disseminated Intravascular Coagulation
- Find and treat the underlying cause e.g. sepsis
- Supportive:
- a. Fresh frozen plasma 10-20ml/kg
- b. Cryoprecipitate (when fibrinogen level <1.5)
- c. Platelet transfusion - Inhibition of the effects of excess thrombin
- Non-bleeding DIC → LMWH
- Regular clinical and laboratory surveillance
What are the complications of Disseminated Intravascular Coagulation
Acute renal failure
Life-threatening haemorrhage
- Cardiac tamponade
- Haemothorax
- Intracerebral haematoma
Gangrene and amputation