2018 / 20 May

Disseminated Intravascular Coagulation: a practical approach


Disseminated intravascular coagulation (DIC) is a syndrome resulting from the inappropriate activation of blood coagulation and formation of microvascular thrombi. During the process, consumption of platelets and coagulation factor occur. In some cases, activation of the fibrinolytic pathway may cause severe bleeding. If sufficiently severe, DIC can produce multiple organ dysfunction syndrome (MODS). Commonly patients with DIC have alterations in prothrombin time, fibrinogen and platelet count. DIC is seen in different clinical circumstances (septicaemic infections, trauma, malignancies, obstetrical complications, vascular diseases, toxic and immunological reactions) and the initial approach should include detailed clinical history and laboratory workup.

DIC occurs at all ages and in all races, and it develops in an estimated 1% of all hospitalized patients. Symptoms include bleeding from venipuncture sites or incisional wounds, bleeding in the gingivae and the gastrointestinal system. Treatment includes correction of the underlying disorder, replacement therapy (eg, platelets, cryoprecipitate, fresh frozen plasma) and sometimes heparin.

References

  • Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care. 2014;2(1):15. doi:10.1186/2052-0492-2-15. (link)
  • Kaneko T, Wada H. Diagnostic criteria and laboratory tests for disseminated intravascular coagulation. J Clin Exp Hematop. 2011;51(2):67-76. (link)
  • Thachil J. Disseminated intravascular coagulation – new pathophysiological concepts and impact on management. Expert Rev Hematol. 2016 Aug;9(8):803-14. doi:10.1080/17474086.2016.1203250. (link)

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