Disseminated Intravascular Coagulation (DIC): Things To Know About DIC

What is disseminated intravascular coagulation?

Disseminated intravascular coagulation (DIC) is a rare, life-threatening condition. In the early stages of the condition, DIC causes your blood to clot excessively. As a result, blood clots may reduce blood flow and block blood from reaching bodily organs. As the condition progresses, platelets and clotting factors, the substances in your blood responsible for forming clots, are used up. When this happens, you will begin to experience excessive bleeding.

DIC is a serious condition that can lead to death. If you have bleeding that won’t stop, go to the nearest hospital for prompt medical treatment.

  Causes of DIC

When you are injured, proteins in the blood that form blood clots travel to the injury site to help stop bleeding. If these proteins become abnormally active throughout the body, you could develop disseminated intravascular coagulation (DIC). The underlying cause is usually due to inflammation, infection, or cancer.

In some cases of DIC, small blood clots form in the blood vessels. Some of these clots can clog the vessels and cut off the normal blood supply to organs such as the liver, brain, or kidneys.

 

Lack of blood flow can damage and cause major injury to the organs.

In other cases of DIC, the clotting proteins in your blood are consumed. When this happens, you may have a high risk of serious bleeding, even from a minor injury or without injury. You may also have bleeding that starts spontaneously (on its own). The disease can also cause your healthy red blood cells to fragment and break up when they travel through the small vessels that are filled with clots.

Risk factors for DIC include:

Blood transfusion reaction

Cancer, especially certain types of leukemia

Inflammation of the pancreas (pancreatitis)

Infection in the blood, especially by bacteria or fungus

Liver disease

Pregnancy complications (such as placenta that is left behind after delivery)

Recent surgery or anesthesia

Severe tissue injury (as in burns and head injury)

Large hemangioma (a blood vessel that is not formed properly).

  Signs And Symptoms of DIC

Signs and symptoms of disseminated intravascular coagulation (DIC) depend on its cause and whether the condition is acute or chronic.

*Acute DIC develops quickly (over hours or days) and is very serious. *Chronic DIC develops more slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC.

With acute DIC, blood clotting in the blood vessels usually occurs first, followed by bleeding. However, bleeding may be the first obvious sign. Serious bleeding can occur very quickly after developing acute DIC. Thus, emergency treatment in a hospital is needed.

Blood clotting also occurs with chronic DIC, but it usually doesn't lead to bleeding. Sometimes chronic DIC has no signs or symptoms.

Signs and Symptoms of Excessive Blood Clotting

In DIC, blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels. This can cause the following signs and symptoms:

Chest pain and shortness of breath if blood clots form in the blood vessels in your lungs and heart.

Pain, redness, warmth, and swelling in the lower leg if blood clots form in the deep veins of your leg.

Headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking and understanding if blood clots form in the blood vessels in your brain.

These signs and symptoms may indicate a stroke.

Heart attack, lung and kidney problems if blood clots lodge in your heart, lungs, or kidneys. These organs may even begin to fail.

 Signs and Symptoms of Bleeding

In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal and external bleeding.

*Internal Bleeding

Internal bleeding can occur in your body's organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:

Blood in your urine from bleeding in your kidneys or bladder.

Blood in your stools from bleeding in your intestines or stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.)

Headaches, double vision, seizures, and other symptoms from bleeding in your brain.

*External Bleeding.

External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)

External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.

How to diagnose DIC?

The diagnosis of DIC is not made on a single laboratory value, but rather the constellation of laboratory markers and a consistent history of an illness known to cause DIC. 

Laboratory markers consistent with DIC include:

Characteristic history (this is important because severe liver disease can essentially have the same laboratory findings as DIC)

Prolongation of the prothrombin time (PT) and the activated partial thromboplastin time (aPTT) reflect the underlying consumption and impaired synthesis of the coagulation cascade.

Fibrinogen level was initially thought to be useful in the diagnosis of DIC but because it is an acute phase reactant, it will be elevated due to the underlying inflammatory condition. Therefore, a normal (or even elevated) level can occur in over 57% of cases. A low level, however, is more consistent with the consumptive process of DIC.

A rapidly declining platelet count

High levels of fibrin degradation products, including D-dimer, are found owing to the intense fibrinolytic activity stimulated by the presence of fibrin in the circulation.

The peripheral blood smear may show fragmented red blood cells (known as schistocytes) due to shear stress from thrombi. However, this finding is neither sensitive nor specific for DIC.

A diagnostic algorithm has been proposed by the International Society of Thrombosis and Haemostasis. This algorithm appears to be 91% sensitive and 97% specific for the diagnosis of overt DIC. A score of 5 or higher is compatible with DIC and it is recommended that the score is repeated daily, while a score below 5 is suggestive but not affirmative for DIC and it is recommended that it is repeated only occasionally. It has been recommended that a scoring system be used in the diagnosis and management of DIC in terms of improving outcome.

Presence of an underlying disorder known to be associated with DIC (no=0, yes=2)

Global coagulation results

Platelet count (> 100k = 0, < 100k = 1, < 50k = 2)

Fibrin degradation products such as D-Dimer (no increase = 0, moderate increase = 2, strong increase = 3)

Prolonged prothrombin time (< 3 sec = 0, > 3 sec = 1, > 6 sec = 2)

Fibrinogen level (> 1.0g/L = 0; < 1.0g/L = 1(15)

How DIC is treated?

Treatment of DIC is centered around treating the underlying condition. Transfusions of platelets or fresh frozen plasma can be considered in cases of significant bleeding, or those with a planned invasive procedure. The target goal of such transfusion depends on the clinical situation. Cryoprecipitate can be considered in those with a low fibrinogen level. Treatment of thrombosis with anticoagulants such as heparin is rarely used due to the risk of bleeding.

Recombinant human activated protein C was previously recommended in those with severe sepsis and DIC, but drotrecogin alfa has been shown to confer no benefit and was withdrawn from the market in 2011.

Recombinant factor VII has been proposed as a "last resort" in those with severe hemorrhage due to obstetric or other causes, but conclusions about its use are still insufficient.

  Prevention of DIC

The key for primary prevention is early treatment of conditions or disorders known to precipitate DIC. Both early identification and prompt treatment of those conditions or disorders are required to reduce the chance of developing DIC.

The most effective prevention for DIC is to actively and aggressively treat the underlying disorder. Other early management to restore normality of the deranged coagulation systems may also be beneficial in preventing the development of DIC. 

Sources:

Wikipedia

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