Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
DIC resident survival guide
Introduction
Overview
Overview
Disseminated intravascular coagulation, is a pathological process in the body where the blood starts to coagulate throughout the whole body.
Causes
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Disseminated intravascular coagulation in itself is a life-threatening condition and must be treated as such irrespective of the cause.
Common Causes
Management
Management
Below is an algorithm showing the initial approach to DIC.
Examine the patient: ❑ Digital ischemia ❑ Hypotension ❑ Fever ❑ Acral cyanosis ❑ Bleeding from wounds/puncture sites ❑ Petechiae ❑ Purpura ❑ Ecchymosis ❑ Bedside Observations :❑ Stroke :❑ Acute MI :❑ ARF :❑ DVT :❑ PE :❑ Purpura fulminans | |||||||||||||
Order tests: ❑ Peripheral blood smear :❑ ↓Platelet count < 100,000/mm³ :❑ + Schistocytes ❑ Clotting screen
Other Investigations ❑ ↑ LDH ❑ ↓Factor V assay ❑ ↓Factor VIII assay ❑ ↓Protein C and Protein S ❑ ↓AT levels | |||||||||||||
Treatment
The goal of treatment of DIC is the treatment of the underlying disorder. Shown below is an algorithm for the general treatment of DIC.
| Actively bleeding | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Platelet transfusion if platelet count < 50,000/mm³ | Fresh frozen plasma 15mg/kg initial dose or 6 units per 24 hours | Cryoprecipitate or Purified Fibrinogen concentrate | Assess for risk of VTE Severe purpura fulminans Acral ischemia or vascular skin infarction | ||||||||||||||||||||||||||||||||||||||||
| High risk | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Unfractionated heparin 10 micron/kg/hr or 300-500U per hour continuous infusion | Low Molecular Weight Heparin | Assess for severe sepsis | |||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||
| Antithrombin III | Recombinant human activated Protein C Continuous infusion 24 microgram/kg/hr for 4days | ||||||||||||||||||||||||||||||||||||||||||
Do’s
Do’s
- The transfusion of platelets should be considered for those patients actively bleeding or at an increased risk of bleeding with a platelet count of less than 50,000 microliter.[1]
- Fibrinogen level should be kept at a level greater than 100mg/dl
- Therapy with heparin used generally for patients with low grade DIC having predominantly thrombotic episodes such as acral ischemia and thrombophlebitis.
Dont’s
Dont’s
- Do not transfuse platelets or plasma based primarily on laboratory results but should generally be for patients who are bleeding.[1]
- Don’t give recombinant human activated protein C to patients with increased risk of bleeding.[1]
- Don’t give recombinant human activated protein C to patients with platelet counts < 30,000 microliter.[1]
- Avoid the intravenous bolus injection of heparin of 50,000-10,000 units.
References
References
- ↑ 1.0 1.1 1.2 1.3 Levi M, Toh CH, Thachil J, Watson HG (2009). “Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology”. Br J Haematol. 145 (1): 24–33. doi:10.1111/j.1365-2141.2009.07600.x. PMID 19222477.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]