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