Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DlC) is a severe blood dotting abnormality that affects multiple organ systems and occurs in patients with a serious preexisting medical or surgical problem. Many conditions have been associated with the development of DlC including infection, acid-base disturbances, malignancies, burns, traumatic injuries, vascular disorders, transfusion reactions, massive transfusions, and obstetric complications. The emergency physician must initiate the treatment for DlC, as well as diagnose and treat the underlying condition.

DlC is characterized by an imbalance in the system of coagulation and fibrinolysis. It is thought to occur as a result of the release of tissue factor that triggers the coagulation cascade. Small fibrin clots are formed and deposited at the same time fibrinolysis is stimulated, and the process results in the consumption of both coagulation factors and platelets.

Causes

Causes of DIC (Disseminated Intravascular Coagulation) can be classified as acute or chronic, systemic. Disseminated Intravascular Coagulation may be the result of a single or multiple conditions.

• Infectious
  • Bacterial
  • Viral ( HIV, cytomegalovirus, varicella, hepatitis)
  • Fungal
  • Parasitic
• Obstetric
  • Placental abruption
• Amniotic fluid embolism
• Malignancy
• Trauma
• Burns
• Motor vehicle accidents
• Snake envenomation

Symptoms

• Bleeding and/or thrombosis
• Bleeding from multiple sites, including areas of venipuncture, into the urine, from the gastrointestinal tract, and most commonly, from the skin and mucous membranes

Signs

• See Thrombocytopenia
• Bleeding
• Purpura
• Signs of microthrombi formation and subsequent tissue ischemia (e.g., gangrene, purpura fulminans, renal cortical necrosis, ARDS) can be seen in any organ system.
• CNS findings stemming from an intracerebral hemorrhage

Treatment

The following DIC is treatment are essential:

• Attend to life-threatening issues such as airway compromise.
• Determine the underlying cause of the patient's DIC and initiate therapy. Obtain appropriate imaging studies if necessary.
• Replace blood products as indicated
  • RBC transfusion
  • Fresh frozen plasma
  • Cryoprecipitate
• Underlying disease
  • Treat the underlying disease.
  • Eg, if infection is the underlying etiology, the appropriate administration of antibiotics and source control is the first line of therapy.