Disseminated Intravascular Coagulation (DIC)

Question 1

what is disseminated intravascular coagulation (DIC)?

Answer 1

a serious disorder occurring in response to an illness or disease process which results in dysregulated blood clotting

Question 2

what is the aetiology of DIC?

Answer 2

• shock
• infection (e.g. sepsis)
• trauma (e.g. burns)
• malignancy (e.g. APML)
• obstetric (e.g. eclampsia, HELLP, placental abruption, intrauterine death, amniotic fluid embolism)
• immune-mediated (e.g. acute haemolytic transfusion reaction)
• organ dysfunction (e.g. severe acute pancreatitis)

Question 3

what are the symptoms of DIC?

Answer 3

• bleeding from unusual sites (e.g. ears, nose, gastrointestinal tract, genitourinary tract, respiratory tract or sites of venepuncture or cannulation)
• bleeding from three unrelated sites is highly suggestive of DIC
• widespread or unexpected bruising without a history of trauma
• new confusion or disorientation (e.g. a sign of microvascular thrombosis affecting cerebral perfusion)

Question 4

what are the non-specific findings on examination of DIC?

Answer 4

• signs of haemorrhage (e.g. bleeding from cannula sites/venepuncture sites, melaena, haematemesis, rectal bleeding, epistaxis, haemoptysis, haematuria)
• petechiae/purpura
• livedo reticularis
• purpura fulminans
• ? gangrene
• confusion
• oliguria
• hypotension
• tachycardia

Question 5

what scoring system is used to diagnose DIC, and what parameters does it assess?

Answer 5

• the international society of thrombosis and haemostasis (ISTH)
• utilises the platelet count, D-dimer value, prothrombin time and fibrinogen levels to assess the likelihood that a patient has DIC

Question 6

what are the laboratory investigations for DIC?

Answer 6

• FBC (e.g. there is typically thrombocytopenia in DIC due to excessive consumption)
• coagulation (e.g. PT, APTT)
• clauss fibrinogen (e.g. typically decreased as fibrinogen is converted to fibrin in intravascular thrombosis)
• D-dimer (e.g. typically raised providing evidence of degradation of fibrin clots around the body)

Question 7

what is the management of DIC?

Answer 7

• platelet transfusions should be considered if the patient is bleeding
• FFP in bleeding patients with a prolonged PT and/or APTT
• concentrated solutions of clotting factors (e.g. prothrombin complex concentrate, or specific factor infusions)
• transfusions of cryoprecipitate or fibrinogen concentrate if there is severely low fibrinogen
• therapeutic doses of heparin if thrombosis is a prominent feature
• if there is co-existing high risk of bleeding, then unfractionated heparin can be used
• in other patients who are non-bleeding, prophylactic doses of heparin are recommended to protect against VTE

Question 8

what are the long-term complications of DIC?

Answer 8

• mutli-organ failure (e.g. acute renal failure, hepatic failure, ARDS)
• life-threatening haemorrhage
• cardiac tamponade
• haemothorax
• intracranial haemorrhage
• gangrene