Disseminated intravascular coagulation
Disseminated intravascular coagulation is a secondary, systemic activation of coagulation and fibrinolysis, most often from sepsis, that simultaneously consumes platelets and clotting factors, causing microvascular thrombosis and bleeding. Diagnosis rests on a laboratory constellation, thrombocytopenia, prolonged PT and aPTT, low fibrinogen, and elevated D-dimer, in a predisposing clinical setting, and management centers on treating the underlying trigger while replacing blood components only for active or high-risk bleeding.
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What this article covers
- Overview
Definition: disseminated intravascular coagulation (DIC) is a systemic activation of coagulation and fibrinolysis, driven by an underlying disease, generating microvascular thrombi while consuming…
- Epidemiology
Sepsis is the dominant trigger: severe sepsis, usually with septic shock and most commonly gram-negative bacteremia, is the most frequent cause in hospitalized patients.
- Risk factors
Severe sepsis and septic shock: the leading predisposing condition, particularly with gram-negative organisms.
- Pathophysiology
Underlying disease triggers the procoagulant system: the inciting condition (sepsis, malignancy, trauma, obstetric injury) exposes tissue factor and generates thrombin systemically.
- Clinical features
Bleeding manifestations, the most common presentation: oozing from surgical wounds and venipuncture or catheter sites, ecchymoses, petechiae, hematomas, vaginal bleeding, and gastrointestinal or genitourinary hemorrhage.
- Differential diagnosis
Thrombotic thrombocytopenic purpura: severe thrombocytopenia and MAHA with schistocytes, but PT and aPTT are typically normal and ADAMTS13 activity is markedly reduced (thrombotic thrombocytopenic purpura).
- Diagnosis
No single confirmatory test; diagnosis rests on the classic laboratory constellation in the right clinical setting: thrombocytopenia, prolonged PT and aPTT, hypofibrinogenemia, and elevated…
- Management
Treat the underlying cause first; this is the essential and only curative step.
- Complications
Multiorgan failure from microvascular thrombosis: acute kidney injury, hypoxemic respiratory failure, and altered mental status from ischemic injury to kidneys, lungs, and brain.
- Prognosis
Outcome tracks the underlying trigger: DIC marks illness severity, and prognosis depends far more on whether sepsis, obstetric hemorrhage, trauma, or malignancy can be controlled than on the coagulopathy itself.
- Prevention
Early recognition and treatment of predisposing conditions: prompt source control and antibiotics for sepsis, timely delivery for placental abruption or amniotic fluid embolism, and rapid hemostatic…
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