DIC

Definition

 

Disseminated Intravascular Coagulation

 

Pathology

 

Results from excessive activation of either extrinsic or intrinsic coagulation pathway

- multiple small clots 

- consumptive coagulopathy

 

1.  Excessive Extrinsic Activation

 

Secondary to extensive cellular destruction

- thromboplastins +++ released into circulation

- these tissue factors activate VII

 

Sepsis with disruption of phagocytes common cause

- numerous other causes

 

2.  Excessive Activation of Intrinsic Pathway

 

Less common

- extensive endothelial damage

 

Aetiology

 

Cancer: lung / pancreas / prostate

Obstetric: abruption / pre-eclampsia / amniotic fluid embolism

Severe trauma and burns

Gram negative sepsis

 

Clinical

 

Bleeding or thromboembolism

 

Bleeding

- more common secondary to thrombocytopaenia or coagulation factor depletion

- surgical sites

- skin / IV lines / venupuncture

- respiratory / urological / GIT

 

Diagnosis

 

Increased PT / APTT

 

Increased

- FDP / fibrin degradation products

 

Decreased

- fibrinogen

- platelets

 

Management

 

Principles

 

Control of underlying disorder

 

Bleeding

 

FFP / Cryoprecipitate

 

Clotting

 

Rarely a problem

- may get CVA or coronary artery thrombosis

- anticoagulate with Heparin