Disseminated Intravascular Coagulation/DIC (1*) Flashcards
What is it?
What feature is highly suggestive of it?
What are its risk factors?
➊ Type of Microangiopathic Haemolytic Anaemia where inappropriate activation of coagulation pathways and subsequent fibrin deposition in small vessels results in thrombus formation and a depletion of platelets and clotting factors
➋ Generalised bleeding in 3+ unrelated sites
➌ Major trauma or burns, Multiple-organ failure, Severe sepsis, Severe obstetric complications, Haematological malignancies
Pathophysiology:
How are immune cells involved here? What does it lead to?
→ How does this affect oxygen transport?
How is the coagulation system involved here?
→ What does this lead to?
➊ They release lots of cytokines, which cause blood vessels to become more permeable – This leads to Oedema
→ Reduces how much oxygen can reach tissues
➋ It’s activated, leading to fibrin deposition in vessels, further affecting tissue perfusion
→ Consumption of platelets and clotting factors as they’re being used up to form clots → Thrombocytopenia, Haemorrhages, and an inability to form new clots and stop bleeding
N.B. Pts go through a phase of widespread clotting, following by haemorrhaging as the platelets and CFs are used up. DIC is usually fatal.
How does it present?
What may be found O/E?
➊ • Epistaxis
• Gingival bleeding
• Haematuria
• Bleeding from cannula sites
➋ Petechiae, Ecchymosis (Bruising), Confusion, Hypotension, Hypoxia
What are the investigations to do? What result is expected?
What is the diagnosis based on?
➊ • Platelets – Decreased (Thrombocytopenia)
• Fibrinogen – Decreased
• D-dimer – Raised
• INR – Raised
➋ The presence of 1+ known underlying cause of DIC + 1 abnormal coagulation test e.g. Low platelets, Raised INR, Raised D-dimer, Low fibrinogen
Management:
How do you manage those with a low bleeding risk?
How do you manage those with a high bleeding risk or actively bleeding?
➊ Treat the underlying disorder
➋ Treat the underlying disorder and give platelets, coagulation factors and inhibitors
• Platelets if < 20 with active bleeding
• FFP for replacement of coagulation factors and inhibitors when significant bleeding or fibrinogen < 100
