Disseminated Intravascular Coagulation (DIC)

Question 1

What can cause DIC?

Answer 1

Infections

Malignancies

Question 2

Which infections/infective organisms can cause DIC?

Answer 2

Meningococcal septicaemia
Escherichia coli
Streptococcus pneumoniae
Malaria

Question 3

Which malignancies tend to cause DIC?

Answer 3

Lung cancer

Pancreatic cancer

Question 4

Pathophysiology of DIC?

Answer 4

• Diffuse endothelial damage (I’m guessing from inflammation) leads to widespread tissue factor expression
• This activates intravascular coagulation and uses up platelets, factors V/VIII, and fibrinogen
• The patient then enters a haemorrhagic state

Question 5

Blood test results in DIC?

Answer 5

Platelets fall (used up)
Hb falls (blood loss)
Fibrinogen falls (used up)

Question 6

How do INR and APTT change in DIC and why?

Answer 6

INR and APTT both increase

- both depend on factor V and fibrinogen

Question 7

Treatment for DIC?

Answer 7

Platelets and/or fresh-frozen plasma

- blood results and clinical scenario guide this