Disseminated Intravascular Coagulation (DIC) Flashcards
Definition of DIC
Is an acquired syndrome that is characterised by the activation of coagulation pathways, resulting in the formation of intravascular thrombi and the DEPLETION of platelets and coagulation factors
• Thrombi can lead to vascular obstruction/ischaemia
• Also risk of bleeding
Aetiology of DIC
• Disease states that can trigger systematic activation of coagulation, and may lead to DIC, are:
◦ Sepsis/severe infection
◦ Major trauma or burns
◦ Some malignancies (acute myelocytic leukaemia)
◦ Obstetric disorders
◦ Severe organ destruction or failure
◦ Toxic/immunological reactions: Blood transfusion
• DIC may be acute or chronic
• Acute: MORE COMMON with rapid onset underlying conditions (e.g major trauma, sepsis and massive blood transfusion)
• Chronic: Associate with less acute disorders such as malignancies
Pathophysiology of DIC
• Is a consumption coagulopathy
• 2 important hallmarks of DIC are:
◦ Continuous generation of intravascular fibrin (due to increase in thrombin production) AND
◦ Consumption/depletion of procoagulants and platelets
• With the increased clotting (widespread clot formation), there is also a decrease in fibrinolysis
• This can block blood vessels and cause ischaemia and then organ failure
• With the depletion of platelets and coagulation factors, other areas of the body may start to bleed with the slightest amount of injury
History and examination of DIC
• Presence of underlying disease
• Fever
• Evidence of shock: oligoruia, hypotension, tachycardia
• Purpurin fulminans, gangrene or a real cyanosis
• Delirium or coma: can be signs of microvascular/macrovascular thrombosis
• Petechia, ecchymosis, oozing, haematuria: Generalised bleeding
Investigations for DIC
• Platelet count: DECREASED due to excessive consumption
• Prothrombin time (PT): often PROLONGED
• D-Dimer: ELEVATED due to large amount of fibrin degradation products
• Fibrinogen: Decreased due to excessive consumption
Treatment for DIC
Low bleeding risk:
1) Treat underlying disorder: Aggressive treatment of underlying disorder. Risk assessment for DIC to measure bleeding risk. Daily scoring needed
High bleeding risk or active bleeding:
1) Treat underlying disorder
+ Platelets AND coagulation factors and coagulation inhibitors:
◦ A platelet transfusion should be considered with bad thrombocytopenia or if low platelets and active bleeding
◦ FFP is preferred for replacement of coagulation factors and coagulation inhibitors
Complications and prognosis of DIC
• Acute renal failure: can lead to this and multi organ failure (due to widespread intravascular thrombosis, leading to organ ischaemia and failure)
• Life threatening haemorrhage: late complication due to depletion of coagulation factors
• Cardiac tamponade, haemothroax, intracerebral haematoma
• Gangrene and loss of digits: due to ischaemia
Mortality can be high