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    Disseminated Intravascular Coagulation

    Disseminated Intravascular Coagulation is a topic covered in the 5-Minute Emergency Consult.

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    Emergency Central

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    Basics

    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) activate the extrinsic pathway, 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

    • 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

    Rosen, Peter, 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/all/Disseminated_Intravascular_Coagulation.
    Disseminated Intravascular Coagulation. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation. Accessed April 26, 2019.
    Disseminated Intravascular Coagulation. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation
    Disseminated Intravascular Coagulation [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Disseminated Intravascular Coagulation ID - 307022 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -