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Disseminated Intravascular Coagulation

Also called consumption coagulopathy and defibrination syndrome, disseminated intravascular coagulation (Die) occurs as a complication of diseases and conditions that accelerate clotting. This accelerated clotting process causes small blood vessel occlusion, organ necrosis, depletion of circulating clotting factors and platelets, and activation of the fibrinolytic system - which, in turn, can provoke severe hemorrhage.

Clotting in the micro circulation usually affects the kidneys and extremities but may occur in the brain, lungs, pituitary and adrenal glands, and GI mucosa. Other conditions, such as vitamin K deficiency, hepatic disease, and anticoagulant therapy, may cause a similar hemorrhage.

DIC is generally an acute condition but may be chronic in cancer patients. The prognosis depends on early detection and treatment, the severity of the hemorrhage, and treatment of the underlying disease or condition.

Causes

Although it is rare, DIC can result from many health conditions, including:

• Some types of bacterial , viral , or fungal infection.
• Severe trauma, especially from brain injuries, crushing injuries, burns, and extremely low body temperature (hypothermia).
• Cancer.
• Complications during pregnancy.
• Snakebite.

In most cases, the condition causing the DIC will be known (such as severe trauma). In rare cases, extensive bleeding caused by DIC will be the first symptom of the disease or condition causing it (such as cancer).

Signs and symptoms

The most significant clinical feature of DIC is abnormal bleeding, without an accompanying history of a serious hemorrhagic disorder.

Principal signs of such bleeding include cutaneous oozing, petechiae, ecchymoses, and hematomas caused by bleeding into the skin. Bleeding from sites of surgical or invasive procedures (such as incisions or I. V. sites) and from the GI tract are equally significant indications, as are acrocyanosis and signs of acute tubular necrosis.

Related symptoms and other possible effects include nausea, vomiting, dyspnea, oliguria, seizures, coma, shock, failure of major organ systems, and severe muscle, back, and abdominal pain.

Diagnosis

Although numerous blood tests are often performed on patients prone to DIC, the important measures are: full blood count (especially the platelet count), fibrin degradation products or D-dimer tests (markers of fibrinolysis ), prothrombin time or INR and fibrinogen levels. Decreased platelets, elevated FDPs or D-dimers, high PT/INR and decreased fibrinogen are markers of DIC.

Treatment

Successful management of DIC necessitates prompt recognition and adequate treatment of the underlying disorder. Treatment may be supportive (when the underlying disorder is self-limiting, for example) or highly specific.

If the patient isn't actively bleeding, supportive care alone may reverse DIC. However, active bleeding may require I. V. heparin and administration of blood, fresh frozen plasma, platelets, or packed RBCs to support hemostasis.

Prevention

Get prompt treatment for conditions known to bring on this disorder.