• Disseminated Intravascular Coagulation

    (DIC; Consumption Coagulopathy; Defibrination Syndrome)

    Definition

    Disseminated intravascular coagulation (DIC) is a serious disruption in the body’s clotting mechanism. Normally, the body forms a blood clot in reaction to an injury. With DIC, the body overproduces many small blood clots throughout the body.
    These small clots are dangerous and can interfere with the blood supply to organs, causing dysfunction and failure. Massive bleeding can occur due to the body’s lack of clotting factor and platelets. DIC is life-threatening and needs to be treated right away.
    Disseminated Intravascular Coagulation
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    Causes

    There are many causes of DIC. The disorder is usually caused by a release of chemicals into the bloodstream from one of the following conditions:
    • Sepsis—a system-wide infection, especially with gram-negative bacteria
    • Labor and delivery complications:
      • Eclampsia
      • Amniotic fluid clots
      • Retained placenta
    • Certain cancers
    • Extensive tissue injury:
    • Reaction to blood transfusion
    • Shock
    • Less common causes include:
      • Severe head trauma
      • Prostate surgery complications
      • Venomous snake bites

    Risk Factors

    Certain conditions increase your chances of developing DIC. When making a diagnosis, your doctor will look for the following risk factors:
    • Recent episode of sepsis
    • Recent injury or trauma
    • Recent surgery or anesthesia
    • Labor and delivery complications
    • Leukemia or widespread cancer
    • Recent reaction to a blood transfusion
    • Severe liver disease

    Symptoms

    Symptoms of DIC can vary in severity, depending on the cause, as well as the time of diagnosis. DIC is a life-threatening condition that must be treated right away. If you experience bleeding that does not stop or bleeding from an unknown source, it is critical to get emergency treatment. Symptoms of DIC include:
      Bleeding
      • Sometimes severe
      • From multiple locations in the body
      • Unknown cause
      • Gastrointestinal bleeding
    • Blood clot formation causing fingers or toes to look blue
    • Sudden bruising

    Diagnosis

    Your doctor will make a diagnosis of DIC based on your signs and symptoms, as well as results of certain blood tests. Blood levels will vary according to the severity of the DIC. Your blood will be examined for abnormal levels of certain tests, including:
    • Platelet count—usually reduced in DIC
    • Fibrinogen—usually reduced in DIC
    • Fibrin degradation products—usually elevated level in DIC
    • Prothrombin time (PT)—usually prolonged in DIC
    • Partial thromboplastin time (PTT)—usually prolonged in DIC
    • Thrombin test time—prolonged in DIC
    • D-dimer test—high level in DIC

    Treatment

    Treatment of DIC depends on identifying and treating the underlying cause quickly. Your doctor may give you certain blood products or medications to treat your condition. Sepsis is usually treated with antibiotics. Treatment options include the following:

    Blood Products

    Fresh frozen plasma is used to replace low levels of coagulation factors caused by DIC. Platelets may also be given to restore low levels. Cryoprecipitates may also be used to correct low levels of fibrinogen.

    Heparin

    Heparin is a blood thinner. Doctors sometimes give heparin in combination with blood products to reduce blood clots. Cancer patients whose DIC is difficult to control may receive heparin to control blood clots.

    Antithrombin III

    This medication is sometimes used to slow down clotting in certain patients.

    Prevention

    To help reduce your chances of getting DIC, make sure you get prompt treatment for any of the conditions that can cause this disorder.

    RESOURCES

    American Medical Association http://www.ama-assn.org

    National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Healthy U http://www.healthyalberta.com

    References

    Bleeding and clotting disorders. The Merck Manual website. Available at: http://www.merck.com/mmhe/sec14/ch173/ch173a.html . Updated May 2006. Accessed March 4, 2013.

    Disseminated intravascular coagulation (DIC). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 13, 2013. Accessed March 4, 2013.

    Karnik L, Murray J. Anticoagulation in the trauma patient. Trauma . 2005;7:63-68.

    Revision Information

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