Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation (DIC) is a blood disorder where there is an excessive blood clotting that may block small blood vessels.

The overwhelming activation of coagulation increase the consumption of platelets and coagulation factors, and in consequence, the risk of hemorrhages in other blood vessels is increased.

A blood clot, also known as a thrombus, is a mass of blood formed when platelets, proteins, and blood cells stick together. The blood clot is the natural way of stopping bleeding from an injury.

However, in case of suffering disseminated intravascular coagulation, there is an abnormal and a significant increase in blood clot formation. These blood clots can obstruct blood flow and cause blockages in some organs, mainly the kidney and lung, followed by the brain, heart, liver, spleen, pancreas and intestine.

DIC occurs as a complication of many other severe medical, surgical or obstetrical conditions such as:

• Malignancy (cancer) especially leukemia
• Obstetric complications (peripartum hemorrhage, placental abruption, preeclampsia, amniotic fluid embolism, etc.)
• Infection (bacteria, fungi, viruses, etc.)
• Trauma, crush injury and burns
• Toxins (Snake bite venom)
• Immune disorders (transfusion reaction or transplant rejection)
• Heart attack or shock
• Vascular malformations (aortic aneurysm, hemangiomas, etc.)
• Kidney failure
• Acute pancreatitis

The main symptoms are related to the excessive blood clotting in some areas of the body that may cause:

• Purpura (purple small flat spots and patches on the skin)
• Peripheral acrocyanosis (hands and feet to turn blue)
• Peripheral gangrene (developed in fingers and toes)
• Bleeding and hemorrhages from many sites in the body

The diagnosis of disseminated intravascular coagulation is based on the clinical evaluation along with the patient medical history and the factors that may trigger the condition.

Laboratory findings suggestive of DIC includes:

• Thrombocytopenia (decrease in platelet count)
• Prolonged prothrombin time (PT)
• Prolonged aPTT (activated partial thromboplastin time)
• Decreased in fibrinogen
• Increase in fibrin degradation products (FDP) including D-dimers

Besides, the presence of schistocytes (fragmented red blood cells) on the peripheral blood is frequently observed.

The cornerstone management of DIC is the adequate treatment of the underlying condition that caused the disorder.

In addition, supportive treatment may be used:

• Fresh frozen plasma transfusions to replace clotting factors.
• Anticoagulants, such as heparin, to prevent the formation of clots.