Disseminated Intravascular Coagulation
Basics
Description
Description
- Normal coagulation: Series of local reactions among blood vessels, platelets, and clotting factors
- Disseminated intravascular coagulation (DIC) is systemic activation of coagulation and fibrinolysis by some other primary disease process
- Coagulation system activation results in systemic circulation of thrombin and plasmin
- Role of thrombin in DIC:
- Tissue factor/factor VIII(a) activates the extrinsic pathway, which leads to thrombin formation
- Thrombin circulates and converts fibrinogen to fibrin monomer
- Fibrin monomer polymerizes into fibrin (clot) in the circulation
- Clots cause microvascular and macrovascular thrombosis with resultant peripheral ischemia and end organ damage
- Platelets become trapped in clot with resultant thrombocytopenia
- Role of plasmin in DIC:
- Plasmin circulates systemically converting fibrinogen into fibrin degradation products (FDPs)
- FDPs combine with fibrin monomers
- FDP-monomer complexes interfere with normal polymerization and impair hemostasis
- FDPs also interfere with platelet function
- Role of impaired anticoagulation in DIC:
- Failure of physiologic anticoagulation is necessary for DIC to occur
- Antithrombin III, protein C system, and tissue factor pathway inhibitor all impaired
- Acute DIC – uncompensated form:
- Clotting factors used more rapidly than body can replace them
- Hemorrhage predominant clinical feature, which overshadows ongoing thrombosis
- Chronic DIC – compensated form:
- Body able to keep up with pace of clotting factor consumption
- Thrombosis predominant clinical feature
Etiology
Etiology
- Precipitated by many disease states
- Complications of pregnancy:
- Retained fetus
- Amniotic fluid embolism
- Placental abruption
- Abortion
- Eclampsia
- HELLP syndrome
- Sepsis:
- Gram negative (endotoxin-mediated meningococcemia)
- Gram positive (mucopolysaccharide-mediated)
- Other microorganisms (e.g., viruses, parasites)
- Trauma:
- Crush injury
- Severe burns
- Severe head injury
- Fat embolism
- Malignancy:
- Solid tumor or metastatic disease
- Hematologic malignancy (e.g., leukemia)
- Intravascular hemolysis:
- Transfusion reactions
- Massive transfusion
- Organ destruction:
- Severe pancreatitis
- Severe hepatic failure
- Vascular abnormalities:
- Kasabach–Merritt syndrome
- Large vascular aneurysm
- Thrombocytopenia:
- Thrombotic thrombocytopenic purpura
- Idiopathic thrombocytopenic purpura
- Miscellaneous:
- Snake bites
- Recreational drugs
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Citation
Schaider, Jeffrey J., et al., editors. "Disseminated Intravascular Coagulation." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/0.1/Disseminated_Intravascular_Coagulation.
Disseminated Intravascular Coagulation. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/0.1/Disseminated_Intravascular_Coagulation. Accessed August 31, 2024.
Disseminated Intravascular Coagulation. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/0.1/Disseminated_Intravascular_Coagulation
Disseminated Intravascular Coagulation [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2024 August 31]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/0.1/Disseminated_Intravascular_Coagulation.
* Article titles in AMA citation format should be in sentence-case
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