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%