Disseminated intravascular coagulation (DIC) is a life-threatening condition (hence the popular alternative definition of “death is coming”) affecting the coagulation cascade. Typically, clot formation and fibrinolysis are carefully balanced by various mechanisms; however, in DIC, these processes are ramped up leading to continued clotting and bleeding.
DIC can be explained as a multifaceted process typically initiated by activation of the coagulation cascade from trauma, burns, malignancy, infection, and even obstetrical complications. This leads to a consumption of factors and platelets and subsequent activation of fibrinolysis. The products of clot degradation then interfere with further primary and secondary hemostasis leading to coagulopathy. End organ function can be compromised by thrombosis and reduced perfusion from shock leading to multisystem organ failure.
This condition can present with ecchymoses and diffuse bleeding from “every site” (PIVs, catheters, drains). Decreased platelets/fibrinogen coupled with prolonged aPTT and PT are indicative of consumptive coagulopathy. Just remember that there is no singular test to diagnose DIC – it’s based on both clinical and lab factors. Although hemodynamic support and resuscitation (ie, transfusion of blood products) are important, identifying and treating the underlying cause is most paramount objective! Supportive measures should focus on the variant of DIC at hand. In other words, massive hemorrhage should be addressed with transfusions and possibly antifibrinolytics or factor concentrates. When thrombosis predominates, consider low molecular weight heparin.
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