Disseminated Intravascular Coagulation (DIC)¶

Hannah Angle, Eric Singhi

Background¶

Abnormal activation of coagulation and fibrinolysis, leading to simultaneous clotting and bleeding
Widespread thrombi formation results in consumption of coagulation factors and platelets (consumption coagulopathy)

Sepsis (especially gram-negative rods), liver disease, pancreatitis, trauma (especially CNS), severe burns, insect/snake venom
Malignancies: acute leukemia (especially APL), mucin-secreting pancreatic/gastric adenocarcinoma, brain tumors, prostate cancer
Obstetric complications: preeclampsia/eclampsia, placental abruption, acute fatty liver of pregnancy
Acute hemolytic transfusion reaction (ABO incompatible transfusion)

Exam findings: petechiae, ecchymoses, bleeding (mucosal, IV sites, surgical wound sites, hematuria), thrombosis (cold, pulseless extremities)
Laboratory evaluation
- Initial workup: CBC, PT/INR, aPTT, fibrinogen, d-dimer, peripheral blood smear
- Serial DIC labs: q6-8h fibrinogen, PT/INR, aPTT (space out when lower risk)
- Lab abnormalities suggestive of DIC: prolonged aPTT and PT/INR, thrombocytopenia, low fibrinogen, elevated D-dimer, schistocytes
- Since Factor VIII is not produced in the liver, it can help distinguish between DIC and liver dysfunction: Factor VIII should be elevated/normal in liver disease and decreased in DIC