Disseminated Intravascular Coagulation (DIC)

Question 1

What is the definition of DIC?

Answer 1

Complex condition that describes the inappropriate activation of the clotting cascades, resulting in thrombus formation and subsequently leading to the depletion of clotting factors and platelets

Question 2

What causes DIC?

Answer 2

Sepsis
Obstetric emergencies
Malignancy
Hypovolaemic shock

Question 3

What is the pathophysiology of DIC?

Answer 3

1. Systemic activation of coagulation by release of pre-coagulant material or cytokine pathways as part of inflammatory response
2. Widespread generation and deposition of fibrin in blood vessels causing thrombosis and multiorgan failure
3. Consumption of platelets and coagulation factors, and secondary activation of fibrinolysis leading to production of FDPs and D-dimer
4. Consequence is mix of initial thrombosis followed by bleeding tendency due to consumption of coagulation factors and dysregulated fibrinolytic activation

Question 4

What does microvascular thrombus in DIC cause?

Answer 4

End organ failure

Question 5

What does clotting factor consumption in DIC cause?

Answer 5

Bruising
Purpura
Generalised bleeding

Question 6

What are some symptoms of DIC?

Answer 6

Excessive bleeding
Fever
Confusion
Potential coma

Question 7

What are some signs of DIC?

Answer 7

Petechiae
Bruising
Confusion
Hypotension

Question 8

What will blood results in DIC show?

Answer 8

Prolonged PT, APTT and TT
Fibrinogen level markedly reduced
High levels of FDPs, D-dimer
Severe thrombocytopenia
Fragmented red blood cells on film

Question 9

What is the management of DIC?

Answer 9

Treat underlying cause
Supportive care (transfusions of platelets or clotting factors, sometimes anticoagulation is necessary)