Editing Disseminated intravascular coagulation

DIC

Disseminated intra-vascular coagulation

* Also called consumption coagulopathy and defibrination syndrome


An acquired syndrome, characterised by the intra-vascular activation of coagulation, with loss of localisation, arising from sepsis

* Typically, sepsis-associated DIC is seen as systemic activation of coagulation with suppressed fibrinolysis in combination with systemic inflammation leading to organ dysfunction

== Presentation ==

* Acute DIC
** Bleeding 64% - oozing from sites of trauma, catheters or drains, or mucosa, petechiae, ecchymosis
** AKI 25%
** Hepatic dysfunction 19%
** Respiratory dysfunction 16%
** Shock 14%
** Thromboembolism 7% - more likely to occur in chronic DIC, can be venous or arterial
** CNS involvement 2%
** Purpura fulminans
*** Extensive tissue thrombosis and haemorrhagic skin necrosis
***

== Diagnosis (clinical AND laboratory diagnosis) ==

* Thrombocytopaenia (usually 20-50)
* Prolonged PT and aPTT
* Low plasma fibrinogen
* Elevated d-dimer
* Reduced levels of procoagulant factors such as factors VII, X, V, and II
* Reduced levels of coagulation inhibitors such as antithrombin, protein C, and protein S
* Blood smear - microangiopathic haemolytic anaemia

== Treatment ==

* Treat underlying cause
* Supportive measures
** RBC transfusion
** Support haemodynamics
* UTD does not suggest routine prophylactic platelets or coagulation factors in patients who are not bleeding, if platelets >10
* Transfuse platelets and FFP if there is serious bleeding

== Prognosis ==

* Laboratory findings and clinical picture generally take a few days to resolve
* Mortality 40-80%

[[Category:Haematology]]