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
- Disseminated microthrombi
- Tissue ischemia
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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