Disseminated Intravascular Coagulation

(DIC)

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Cause Definition

-  Systemic thrombohaemorrhagic disorder ass w fibrin formation & consumption of clotting factors & platelets

-  Characterised by intravascular coagulation, haemorrhage & end-organ damage

 

Features

-  Medical emergency

-  Acute vs chronic

-  Small clots form within vessels --> emboli ---> infarcts

-  Consumption of clotting factors then predisposes to massive haemorrhage

-  Estimated 1% hospitalised pts

 

Causes

-  Inflammation

-  Infection

-  Ca

 

Risk Factors

-  Blood transfusion reactions

-  Ca: Leukaemia..

-  Sepsis, bacteraemia (fungal, viral, parasites)

-  Retained placenta, amniotic fluid embolism, abruptio placenta

-  Burns

-  Head Iinjury, trauma

-  Severe liver disease

-  SLE, Stills disease

 

Associated S/S

-  Bleeding diathesis 60%: multiple haemorrhages, bruising

-  Hypotension: shock 15%

 

DDx

-  TTP – HUS

-  ITP

-  Systemic Inflammatory Response Syndrome

 

Dx: Int. Soc on Thrombosis & Haemostasis

-  Score >5 = DIC

-  Score <5 +/- DIC

-  93% sens, 98% spec

-  Plts

-  >100 = 0

-  <100 = 1

-  <50 = 2

-  D-Dimer/FDP

-  Normal = 0

-  Mod increase = 2

-  Elevated = 3

-  PT

-  < 3sec = 0

-  3-6 sec = 1

-  > 6sec = 2

-  Fibrinogen

-  > 1g/L = 0

-  < 1g/L = 1

 

Ix

-  FBE + Blood film

-  Plts: low

-  D-Dimer + Fibrin degredation products (FDP)

-  APTT & PT: elevated

-  Serum fibrinogen: low

-  Imaging as per S/S

 

Mx

-  Underlying cause

-  +/- Heparin

-  +/- Fresh frozen plasma (FFP) if Plt < 20x10(6)

-  +/- Antithrombin III

-  +/- Protein C

-  +/- Blood transfusion