DIC

Question 1

What is disseminated intravascular coagulation (DIC)?

Answer 1

A complex condition that describes the inappropriate activation of clotting cascades, resulting in thrombus formation and then leading to the depletion of clotting factors and platelets.

Question 2

What are the causes of DIC?

Answer 2

Sepsis

Obstetric emergencies

Malignancy

Hypovolaemic shock

Question 3

How does DIC arise?

Answer 3

Arises because of systemic activation of coagulation either by release of procoagulant material, such as tissue factor or via cytokine response due to inflammatory response

Question 4

What does the systemic activation of coagulation lead to?

Answer 4

Leads to widespread generation of fibrin and deposition in blood vessels, leading to thrombosis and multiorgan failure.

Question 5

Why is the FDP and D-dimer count high?

Answer 5

Due to widespread coagulation activation there is consumption of platelets and coagulation factors, there is secondary activation of fibrinolysis leading to production of FDP’s and d-dimer.

Question 6

Clinical presentation of DIC?

Answer 6

• Patient often acutely ill and shocked.
• Clinical presentation varies from no bleeding at all to profound haemostatic failure with widespread haemorrhage.

Question 7

Symptoms of DIC?

Answer 7

• Excessive bleeding e.g. epistaxis, gingival bleeding, haematuria and bleeding from cannula sites.
• Fever
• Confusion
• Potential coma

Question 8

Signs of DIC?

Answer 8

Petechiae (small purple spots caused by bleeding into the skin)

Bruising

Confusion

Hypotension

Question 9

Investigations for DIC?

Answer 9

Difference blood tests would be carried out:

• The PT, APTT and TT are usually very prolonged and the fibrinogen level is markedly reduced.
• High levels of FDPs (fibrin degradation products), including D-dimer, are found, owing to the intense fibrinolytic activity stimulated by the presence of fibrin in the circulation.
• Severe thrombocytopenia
• Blood film may show fragmented red blood cells.

Question 10

Management of DIC?

Answer 10

• Treat the underlying cause
• Supportive care includes transfusions of platelets or clotting factors, and in some cases anticoagulation therapy may be necessary.

Question 11

What is fibrinolysis?

Answer 11

The enzymatic breakdown of fibrin in blood clots.