Disseminated Intravascular Coagulation (DIC) Overview Increased Clotting and Consumption of Clotting Factors Findings: • Bleeding • Recent history of trauma, sepsis, malignancy (Especially acute promyelocytic leukemia) or ABO incompatible blood transfusion • Thrombocytopenia • Prolonged PT/PTT • Low plasma fibrinogen • Elevated D-Dimer • Increased thrombin time • Reduced levels of factors VII, X, V and II • Reduced levels of antithrombin, protein C and S Pathophysiology: • Process is simultaneous coagulation and fibrinolysis • Procoagulant Exposure → Tissue factor → Fibrinolysis → End organ damage Clinical Findings: • Bleeding (64%) • Renal dysfunction (25%) • Hepatic dysfunction (19%) • Respiratory dysfunction (16%) • Shock (14%) • Thromboembolism (7%) • CNS involvement (2%) Cutaneous Manifestations of DIC: • Petechiae • Purpura • Palpable variants of both • Acral cyanosis • Hemorrhagic bullae • Purpura fulminans • Subcutaneous dissecting hematoma • Bleeding from wound or venipuncture sites Laboratory Findings in DIC: • Platelet count: ↓ • Fibrinogen: ↓ • PT/INR: ↑ • PTT: ↑ • D-Dimer: ↑ • Peripheral smear: Schistocytes, helmet cells DDX: • TMA’s (HUS/TTP/DITMA) - MAHA + Thrombocytopenia - Platelet rich microthrombi without significant fibrin clot formation or consumption coagulopathy - Thrombocytopenia - Normal coagulation studies - PBS: + Schistocytes - MAHA: TTP/HUS > DIC • Severe Liver Disease: - Impaired synthesis of coagulation factors - Reduction of pro/anticoagulants - Thrombocytopenia - bleeding or thrombosis (Hypersplenism and thrombopoietin deficiency) • HIT: Heparin-PF4 antibodies/SRA - + Thrombosis - + Bleeding Treatment: • Treat primary cause • Correct coagulation abnormalities - PLT, FFP, Cryoprecipitate - PLT > 50,000 - Fibrinogen > 150 (Cryoprecipitate to increase > 100mg/dL) - Heparin if presence of large thrombosis - Hg > 7 - INR < 2.3 - APTT < 1.5 x normal Supportive Measures: • Hemodynamic/Ventilatory support • Aggressive hydration • RBC transfusion for bleeding #DIC #Disseminated #Intravascular #Coagulation #diagnosis #causes #treatment #management #hematology
