Disseminated Intravascular
Coagulation (DIC)
Bryan Imayanagita
Background
Pathological activation
Formation of clots throughout the body in
the blood vessels
Leads to abnormal bleeding; can cause
clots that disrupt blood flow to organs
Multiple organ failure and death
Causes
Sepsis (most common)
endothelial cell damage (heat stroke,
shock)
obstetrical complications
neoplasias
trauma
Pathophysiology
fire/fire extinguisher analogy in normal
coagulation
Thrombin (fire) generation at the site of injury
The endothelium (fire extinguisher) expresses
antithrombin molecules which will bind to
thrombomodulin
No endothelium at damaged tissue site; allows
coaguation. Stopped once thrombin reaches
healthy tissue.
In DIC, coagulation and anti-coagulation out of
balance
Diagnosis
Bleeding from 3 unrelated sites
History of blood loss, hypovolemia
DVT, microvascular thrombosis
Main Features of DIC
Features
Bleeding
Affected
Patients, %
64%
Renal dysfunction
25%
Hepatic dysfunction
19%
Respiratory dysfunction
16%
Shock
14%
Central nervous system
dysfunction
2%
Treatment
Determined if patient is bleeding or needs
an invasive procedure
– If either is positive: fresh frozen plasma or
cryoprecipitate can be given
Folic acid
Heparin treatment not established
– May not be effective; needs anti-thrombin for
anticoagulant activity, reduced by DIC
Prognosis
10%-50% mortality rate
DIC with sepsis significantly higher than
DIC with trauma
Sources
http://www.medstudents.com.br/terin/terin2
.htm
http://emedicine.medscape.com/article/77
9097-overview