Disseminated Intravascular Coagulation (DIC)

Question 1

Pathophysiology of DIC (4).

Answer 1

1. Dysregulation of Coagulation and Fibrinolysis (usually coupled).
2. Widespread Clotting with Resultant Bleeding.
3. Release of Transmembrane Glycoprotein Tissue Factor (TF) - usually not exposed to circulation.
4. TF binds to coagulation factors and triggers extrinsic pathway and then intrinsic pathway subsequently.

Question 2

Aetiology of DIC (5).

Answer 2

1. Sepsis.
2. Major Trauma/Burns.
3. Obstetric Complications e.g. Amniotic Fluid Embolism, HELLP Syndrome.
4. Malignancy.
5. Multiple organ Failure.

Question 3

Which haematological malignancy is most associated with DIC?

Answer 3

Acute Promyelocytic Leukaemia - uncommon type of acute myeloid leukaemia.

Question 4

Investigations of DIC (6).

Answer 4

1. Prolonged PT.
2. Prolonged APTT.
3. Prolonged Bleeding Time.
4. Low Platelets.
5. Increased Fibrin Degradation Products e.g. D-Dimer and Decreased Fibrinogen.
6. Schistocytes - Microangiopathic Haemolytic Anaemia.

Question 5

Investigations of Warfarin Administration (4).

Answer 5

1. Prolonged PT.
2. Normal APTT.
3. Normal Bleeding Time.
4. Normal Platelets.

Question 6

Investigations of Aspirin Administration’s (4).

Answer 6

1. Normal PT.
2. Normal APTT.
3. Prolonged Bleeding Time.
4. Normal Platelets.

Question 7

Investigations of Heparin Administration (4).

Answer 7

1. Normal PT (can be Prolonged).
2. Prolonged APTT.
3. Normal Bleeding Time.
4. Normal Platelets.