Disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC)
Updated: 07/25/2023
© Jun Wang, MD, PhD

General features
  • Acquired syndrome arising from various causes
  • Characterized by systemic, massive, sustained and excessive activation of coagulation
  • High risk of life threatening bleeding
  • Diagnosed based on clinical presentation and laboratory findings
Clinical presentations
  • Symptoms associated with tissue ischemia
Acute renal failure
Jaundice due to liver dysfunction
Acute lung injury: Hemorrhage, acute respiratory distress syndrome
Neurological dysfunction: Change of mental status
Adrenal failure: Due to adrenal hemorrhage or infarction
  • Multiple organ dysfunction
  • Bleeding, thrombosis, or both
  • Acute: Usually hemorrhage, such as petechiae, ecchymosis
  • Chronic: Venous thromboembolism more common
Etiology
  • Infection/sepsis: Most common, includes bacterial, viral, fungal, rickettsial and protozoal organisms
  • Tissue damage: Trauma (2nd most common, head injury or extensive surgery), burns
  • Malignancy: Usually chronic DIC, except APL with PML-RARA
  • Obstetric complications: Abruptio placentae, retained dead fetus syndrome, preeclampsia and eclampsia, amniotic fluid embolism, acute fatty liver of pregnancy, septic abortion
  • Miscellaneous: Near drowning, fat embolism, snake bites, aortic aneurism, acute hemolytic transfusion reaction, adult respiratory distress syndrome, giant hemangioma, homozygous protein C deficiency)
Key pathogenesis
  • Systemic activation of platelets and coagulation cascades
  • Subsequent depletion of coagulation factors
Key Laboratory findings
  • Usually more several in acute DIC
  • Prolonged: PT, aPTT, thrombin time
  • Reduced: Platelet count, fibrinogen, factor V, factor VIII
  • Elevated: FDP, D-dimer (Also seen in chronic DIC)
Key morphological features
Differential diagnosis
  • TTP: Clinical setting, normal PT and PTT, low ADAMTS13
  • HIT: History of heparin usage, normal PT, aPTT and fibrinogen, antibodies against PF4
Management
  • Treated at hospital with appropriate critical care unit and blood bank
  • Treat underlying disorders
  • Supportive


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