Red Book - DIC

Question 1

What is DIC

Answer 1

An acquired syndrome

Characterised by intravascular actiation of coagulation

With loss of localisation from different causes.

Can originate from and cause severe damage to microvasculature

Which if severe can produce organ dysfunction

OR

Dysregulated host response to triggers

Question 2

Triggers for DIC

Answer 2

Sepsis

Trauma - burns and rhabdo

Obstetrics - AFE, placental abruption, pre-eclampsia, PPH

Question 3

Pathology of DIC

Answer 3

excess thrombin generation

increased thrombogenesis occurs with increased fibrinolysis

Simultaneous thrombosis AND bleeding

Normally - thrombin is both pro and anticoagulant.

Severe trigger - excess thrombin —> overwhelemd regulatory processes

No more localisation and disseminates systemically.

Fibrinolytic path tries to counteract clot formation, large volume of fibrin degradation products

Question 4

Features of DIC

Answer 4

Bleeding and thrombis releated

Bleeding -
Skin is first manifestiation —> echymoses, petechiae
Bleeding from skin punctures
Mucosal bleeding —> hyperfibrinolysis - GI bleeds

Thrombosis - 
	AKI
	Hepatic dysfunction
	Resp - alveolar haemorrhage, ARDS
	CNS - vessel occlusion, SAH, haemorrhages and infarcts

Question 5

Diagnosis of DIC

Answer 5

ISTH Score >5

TEG/ROTEM —> early —> hypercoagulable start (short R, increased a angle, increased MA, high lysis.
late —> hypocoag —> prolonged R, reduced a, low MA

Question 6

Features of the ISTH score

Answer 6

Underlying pre-disposing condition —> essential

Plt Count

FDP/D Dimer

Fibrinogen <1

PT prolonged

Question 7

Managment of DIC

Answer 7

ABCDE etc

Treat underlying cause

1) blood products - RBC aim Hb>90 is acutely bleeding
FFP if INR>1.5 or APTT ratio > 1.5
Plts if <50
Cryo (2 pools) OR fibrinogen conc if fibrinogen <1

2) thromboprophylaxis
If risk of bleed high (unfractionated heparin)

AVOID TXA —> inhibiting fibrinolysis may make things worse