Disseminated intravascular coagulation

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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Secret collector of interesting anonymised ECGs. Fan of the Bath Photomarathon. Lover of cream teas. [Sarah Hudson] (Your Picture)