Disseminated Intravascular Coagulation

Question 1

Define DIC

Answer 1

Acquired syndrome characterised by activation of coagulation pathways and depletion of platelets and coagulation factors

Question 2

What are the two forms of DIC

Answer 2

1. Acute overt form: bleeding and depletion of platelets and clotting factors
2. Chronic non-overt form: thromboembolism is accompanied by generalised activation of the coagulation system

Question 3

Aetiology of DIC

Answer 3

Infection/sepsis
Major trauma and burns
Cancer e.g. AML, metastatic mucin-secreting adenocarcinoma
Obstetric: amniotic fluid embolism, eclampsia
Pancreatitis
Blood transfusion reaction

Question 4

Difference between acute and chronic DIC aetiology

Answer 4

Acute - more common with rapid-onset underlying conditions e.g. major trauma, sepsis/severe infection, massive blood transfusion

Chronic more common with non-acute disorders e.g. malignancies, PN haemoglobinuria, Raynaud’s disease.

Question 5

Symptoms of DIC

Answer 5

Dyspnoea 
Delirium or coma
Haematuria, bruising or other evidence of bleeding
Oliguria
Gangrene

Question 6

Signs of DIC

Answer 6

Bleeds: petechiae, purple ecchymoses, haematuria, epistaxis, mucosal

Haemolytic jaundice: jaundice, conjunctival pallor

Signs of underlying cause

Chronic: signs of DVT or arterial thrombosis/embolism

Question 7

Blood investigations taken for DIC

Answer 7

FBC and platelets: Macrocytic anaemia, thrombocytopenia

Clotting studies: Prolonged APTT and PT

Fibrinogen and FDPs: reduced and raised

D-dimer: raised

Blood film: schistocytes