Disseminated Intravascular Coagulation
Disseminated Intravascular Coagulation is a topic covered in the 5-Minute Emergency Consult.
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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) 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
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
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TY - ELEC
T1 - Disseminated Intravascular Coagulation
ID - 307022
ED - Barkin,Adam Z,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Shayne,Philip,
ED - Wolfe,Richard E,
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 -