DIC is a systemic, pathological activation of coagulation that leads to widespread microvascular thrombosis and simultaneous bleeding due to consumption of clotting factors and platelets. It is secondary to an underlying condition such as sepsis, trauma, malignancy, or obstetric complications.
- Pathophysiology
- Trigger
- Extrinsic pathway- Tissue thromboplastins from blunt trauma, burns and surgery
- Intrinsic pathway- endothelial injury, endotoxins, hypothermia, acidosis, platelet activation
- Microvascular Thrombosis
- Widespread thrombin generation leads to fibrin deposition in small vessels, causing organ ischemia and microvascular damage.
- Consumptive Coagulopathy
- Consumption of red cells, platelets, clotting factors, and fibrinogen
- Protein C activation
- Fibrinolysis
- Activation of plasmin leads to fibrinolysis and increased production of fibrin degradation products (FDPs), contributing to bleeding.
- FDPs disrupt normal fibrin polymarisation and fibrinogen binding to platelet surfaces, intergering with clot formation and platelet aggregation.
- Bleeding
- Due to coagulopathy
- Trigger
- Cause
- Sepsis
- Malignancy
- Trauma
- Obstetric complications
- Clinical manifestiations
- Bleeding
- Petechiae and еϲϲhуmoѕеѕ
- Blood ооzing from ԝоսոd sites, intravenous lines, catheters, mucosal surfaces
- For patients who develop DIC after surgical procedures, accumulation of blood in serous cavities
- Thrombosis
- Venous thrοmbоеmboliѕm (VΤЕ)
- Arterial thrοmbоsiѕ with tissue or organ ischemia
- In patients with chronic DIС in the setting of mаligոаոϲy, non-bacterial thrombotic endocarditis (marantic endocarditis, Libman-Sacks endocarditis, verrucous endocarditis) and superficial migratory thrombophlebitis (Trousseau’s syndrome).
- Organ dysfunction
- Renal, liver, lung, neurologic, adrenal
- Purpura fulminans
- Associated with genetic or acquired protein C deficiency
- Bleeding
- Investigations
| Parameter | Acute (decompensated) DIC | Chronic (compensated) DIC |
|---|---|---|
| Platelet count | Reduced | Variable |
| Prothrombin time (PT) | Prolonged | Normal |
| Activated partial thromboplastin time (aPTT) | Prolonged | Normal |
| Thrombin time | Prolonged | Normal to slightly prolonged |
| Plasma fibrinogen | Reduced | Normal to elevated |
| Plasma factor V | Reduced | Normal |
| Plasma factor VIII | Reduced | Normal |
| Fibrin degradation products | Elevated | Elevated |
| D-dimer | Elevated | Elevated |
- Management
- Treat underlying cause
- Supportive care
- May require Platelets, FFP and blood if bleeding
- TXA contra-indicated, could be considered in life threatening bleeding
- Heparin for severe thrombosis
- Purpura fulminans
- Protein C concentrate