Difference between revisions of "Disseminated intravascular coagulation"

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*Infection (most common cause)
**Most common cause of DIC
**10%–20% of pts w/ Gram-neg sepsis have DIC
***Septic pts more likely to have bleeding than thrombosis
**More likely to develop in asplenic pts or cirrhosis

Revision as of 05:18, 6 June 2015


  • Widespread and inappropriate activation of the coagulation and fibrinolytic systems
    • Exposure of blood to procoagulants such as tissue factor and cancer procoagulant
    • Formation of fibrin within the circulation
    • Fibrinolysis
    • Depletion of clotting factors
    • End-organ damage
  • Chronic DIC occurs when hepatic/bone marrow production balances coag factor consumption


Clinical Features

  • In given pt either bleeding or thrombosis will predominate
    • Bleeding is more common (65% of pts)
      • Ranges from petechiae/ecchymosis to life-threatening GI/CNS/pulm bleeding
      • Shock occurs in 15%
    • Renal failure (25-40%)
    • Hepatic dysfunction (19%)
    • Respiratory dysfunction (16%)
    • Thromboembolism (7%)
    • CNS involvement (2%)
    • Purpura fulminans (widespread arterial and venous thromboses)
      • Associated w/ significant bacteremia

Differential Diagnosis

    • Pts usually have little or no prolongation of PT or PTT
  • Severe liver disease
    • Also a/w prolonged PT/PTT, thrombocytopenia, incr D-dimer, incr FDPs
      • However, D-dimer is usually only mildly elevated
  • Heparin-induced thrombocytopenia


Decreased production

Increased platelet destruction or use

Drug Induced

Comparison by Etiology

↓ PLT Yes Yes Yes Yes Yes
↑PT/INR No No No +/- Yes
MAHA No Yes Yes No Yes
↓ Fibrinogen No No No No Yes
Ok to give PLT Yes No No No Yes


  • Acute DIC
    • Platlets
      • Low (or dropping)
      • Sn, not Sp
    • PT
      • Prolonged
    • Fibrinogen
      • Low
      • <100 correlates w/ severe DIC
      • May be normal (acute phase reactant)
    • PTT
      • Prolonged
    • FDP
      • Elevated
    • D-dimer
      • Elevated
      • Sn but not Sp: may also see in pts w/ chronic liver or renal disease
    • RBCs
      • Fragmented (not specific)
  • Chronic DIC
    • FDP: Elevated
    • D-dimer: Elevated
    • Platelet: Variable
    • Fibrinogen: Normal-elevated
    • PT: Normal
    • PTT: Normal
    • RBCs
      • Fragmented


  • Treat underlying illness
  • Replacement tx
    • Only indicated in pts w/ documented DIC + bleeding or impending procedure
      • Fibrinogen
        • Consider repletion w/ cryoprecipitate to raise level to 100-150
      • Platelets
        • Consider repletion if <50K w/ bleeding or <20K without bleeding
      • FFP
      • Vitamin K
      • Folate
    • Heparin
      • Consider only in pts w/ thromboembolic predominant symptoms from chronic DIC

See Also