Disseminated intravascular coagulation (DIC) is the pathological widespread activation of coagulation, resulting in thrombosis, haemorrhage or both.
Blood tests will show:
- prolonged PT
- prolonged aPTT
- massively raised d-dimer levels
- low platelets
- low fibrinogen
- schistocytes – around 50% of cases
Of these, it is the level of fibrinogen which best correlates to the severity – but note that as it is an acute phase protein it may initially be high so take time to become low.
Causes of DIC include:
- obstetric – multiple, including placental abruption, HELLP
- trauma – crush injury, burns, frostbite
- septicaemia
- malignancy
- immune-mediated: transfusion reaction, severe allergic reaction, acute transplant rejection
- toxins – bites, amphetamine overdose
The treatment is:
- treat the cause
- give platelets if platelets <50
- cryoprecipitate – this replaces fibrinogen
- FFP
- activated protein C if septic.
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