Disseminated Intravascular Coagulation

Question 1

Define:

Answer 1

A disorder of the clotting cascade that can complicate a serious illness

-Essentially there are too many clots forming but also an increase in bleeding due to the lack of platelets circulating to start the cascade

Question 2

What are the two types:

Answer 2

Chronic- thromboembolism accompanied by generalised activation of the cascade

Acute = bleeding and depletion of platelets and clotting factors

Question 3

Aetiology/risk factors:

Answer 3

• Infection - particularly GRAM-NEGATIVE sepsis
• Obstetric Complications
o Missed miscarriage (when the foetus dies but the body doesn’t realise it and the placenta continues to release hormones)
o Severe pre-eclampsia
o Placental abruption (separation of the placenta from the wall of the uterus during pregnancy)
o Amniotic emboli
• Malignancy
o Acute promyelocytic leukaemia - ACUTE DIC
o Lung, breast and GI malignancy - CHRONIC DIC
• Severe trauma or surgery
• Others: haemolytic transfusion reaction, burns, severe liver disease, aortic aneurysms, haemangiomas

Question 4

Epidemiology:

Answer 4

Seen in severely unwell patients

Question 5

Symptoms:

Answer 5

Will be very unwell and so there will be symptoms of the underlying cause

Dyspnoea
Confusion
Evidence of bleeding

Question 6

Signs of acute:

Answer 6

Signs of the underlying cause 
Petechiae
Purpura
Ecchymoses 
Mucosal bleeding 
End organ failure 
Oliguria due to the renal failure 
Evidence of shock - hypotension and tachycardia 
Fever 
Epistaxis 
Overt haemorrhage 
Resp distress

Question 7

Signs of chronic:

Answer 7

Fever
Signs of the underlying cause
Signs of shock - hypotension and tachycardia
Evidence of deep veins and arterial thrombosis or embolism
Superficial vein thrombosis

Question 8

Investigations:

Answer 8

FBC:

• Low Hb
• Low platelets
• High D dimers
• High fibrin degradation products
• Low fibrinogen
• High APTT/PT

Peripheral blood film = schistocytes