Disseminated Intravascular Coagulation (DIC)

Question 1

Disseminated intravascular coagulation (DIC) as a syndrome characterised by the systemic activation of blood coagulation, which generates intravascular fibrin, leading to thrombosis of small- and medium‐sized vessels, and eventually organ dysfunction. Does this lead to excess thrombosis formation (clotting) or haemorrhage?

Answer 1

• both

Initially excessive primary haemostasis (thrombosis)

All clotting factors are used leading to haemorrhages

Question 2

Which of the following is NOT a common cause of Disseminated intravascular coagulation (DIC)?

1 - Infection
2 - Malignancy
3 - Excessive sedentary activity
4 - Trauma (surgery, burns, shock)
5 - Liver disease
6 - Obstetric complications

Answer 2

3 - Excessive sedentary activity

Typically there is a procoagulant that triggers increased formation of new clots

Question 3

Initially Disseminated intravascular coagulation (DIC) causes excessive thrombosis in blood vessels, which can have what effect on organs?

1 - hyper perfusion and oedema
2 - hypo-perfusion and oedema
3 - hypo-perfusion and tissue ischaemia
4 - hyper-perfusion and tissue ischaemia

Answer 3

3 - hypo-perfusion and tissue ischaemia

Medium and small blood vessels become blocked by thromboses

Question 4

Initially Disseminated intravascular coagulation (DIC) causes excessive thrombosis in small and medium blood vessels, which can cause hypo-perfusion and tissue ischaemia. The following organs can be typically affected by DIC, but which is least affected?

1 - liver
2 - lungs
3 - heart
4 - kidney
5 - brain

Answer 4

3 - heart

Can be affected but has a good reserve

Other organs likely to be affected more due to higher levels of tissue factor, which is a critical mediator of DIC.

Question 5

Following excessive thrombosis and coagulation, the factors involved in clotting are depleted leading to increased risk of haemorrhages. Which of the following investigations would be true in DIC?

1 -thrombocytopenia
2 - prolonged APTT,
3 - prolonged prothrombin and bleeding time
4 - reduced fibrinogen
5 - increased fibrin degradation products (d-dimer)
6 - Schistocytes due to microangiopathic haemolytic anaemia (damaged RBCs)
7 - all of the above

Answer 5

7 - all of the above

Question 6

When treating a patient with disseminated intravascular coagulation (DIC), the trigger of the DIC needs to be addressed. For example if infection with sepsis, we treat with sepsis 6. We would also do which of the following?

1 - broad spectrum antibiotics
2 - platelet transfusion
3 - platelets or plasma transfusion
4 - fresh frozen plasma products
5 - organ support (ventilator, catheter)
6 - all of the above

Answer 6

6 - all of the above