DIC

Disseminated Intravascular Coagulation (DIC) - Eric Singhi

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