Background
- Concurrent activation of the coagulation pathway and fibrinolytic pathway
- Widespread endothelial injury + exposure to circulating procoagulants activation of coagulation cascade thrombin production in small and medium-sized vessels
- Consumption of platelets, fibrin, and coagulation factors -> fibrinolysis -> end organ damage and hemolysis
- Etiologies:
- Infection/Sepsis, Liver disease, Pancreatitis, Trauma
- Malignancies: mucin-secreting pancreatic/gastric adenocarcinoma, brain tumors, prostate cancer, all acute leukemias, acute promyelocytic leukemia
- Obstetric complications (i.e. preeclampsia/eclampsia, placental abruption)
- Acute hemolytic transfusion reaction (i.e. ABO incompatible transfusion)
Evaluation
- Exam: petechiae, bleeding (mucosal, IV site, surgical wound site, hematuria), ecchymoses, thrombosis (i.e. cold, pulseless extremities)
- CBC, PT/INR, aPTT, Fibrinogen, D-Dimer, Peripheral Blood Smear
- “DIC labs” = q6h fibrinogen, PT/INR, aPTT (space out when lower risk)
- Findings suggestive of DIC: thrombocytopenia, prolonged aPTT and PT/INR, hypofibrinogenemia, elevated D-dimer, fibrin degradation products, schistocytes
Management
- Treat the underlying cause!
- Hemodynamic support (i.e. hypotension): Intravenous fluid resuscitation
- Vitamin K for INR > 1.7 or bleeding
- If bleeding consider FFP, Vitamin K to correct coagulopathy
- Hypofibrinogenemia treatment: Cryoprecipitate 5-10 units if fibrinogen < 100
- Thrombocytopenia treatment: plt transfusion as normally indicated
- DVT ppx if not bleeding and plt > 50
- VTE: anticoagulation if plt > 50 and no massive bleeding