Disseminated intravascular coagulation

Author: Vanessa Ngan, Staff Writer, 2005.

What is disseminated intravascular coagulation (DIC)?

DIC presents in a very ill patient as bleeding into the skin (purpura) and other tissues. It arises as a complication of different serious and life-threatening diseases. It covers the continuum of events that occur in the coagulation pathway. Initially there is uncontrolled activation of clotting factors in the blood vessels, causing clotting of blood throughout the whole body. This depletes the body of its platelets and coagulation factors and results in a paradoxical increased risk of bleeding (haemorrhaging).

Hence, patients with DIC have a loss of balance between the clot-forming activity of thrombin (enzyme that causes blood to clot) and the clot-lysing activity of plasmin (enzyme that dissolves blood clots). DIC is not a specific diagnosis and its presence always indicates another underlying disease.

Classification of DIC

There are two clinical forms of DIC, acute DIC and chronic DIC.

What causes DIC?

Acute DIC is a bleeding disorder caused by a number of conditions.

Chronic DIC is a thromboembolic disorder that is usually associated with:

What are the signs and symptoms of DIC?

Acute DICChronic DIC
  • Multiple bleeding sites
  • Bruising of skin, mucous membranes
  • Internal bleeding
  • Lack of blood supply to tissues (ischaemia)
  • Sudden onset of high fever, severe general malaise, and extensive purpura of the extremities
  • Petechiae, purpuric papules, blood-filled blisters and bluish fingers and toes
  • Deep vein or arterial thrombosis or embolism (clots)
  • Superficial venous thrombosis, especially without varicose veins
  • Multiple thrombotic sites at the same time
  • Serial thrombotic episodes

What is the treatment for DIC?

Identifying and treating the underlying disease is the mainstay of management for both acute and chronic DIC. Specific treatment of DIC may or may not be required depending on the signs and symptoms present.

Management of acute DIC
Without bleeding or evidence of ischaemia No treatment required, observe
With bleeding Blood components:
  • Fresh frozen plasma
  • Cryoprecipitate
  • Platelet transfusions
With ischaemia Anticoagulants such as heparin or low molecular weight heparin (LMWH) after bleeding is corrected with blood products
Management of chronic DIC
Without thromboembolism No specific therapy but prophylactic anticoagulants (e.g. low-dose heparin, LMWH) may be used for patients at high risk of thrombosis
With thromboembolism Anticoagulant therapy with heparin or LMWH
Trial of warfarin (variable response between patients)

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