1. Generation of a hyperthrombinemic state.
2. Alteration of the physiological anticoagulants levels.
3. Impaired fibrinolysis at the onset of DIC.
4. Activation and liberation of inflammatory cytokines in the
pathogenesis of DIC.
Generation of hyperethrombinemic state
1. The exposing of the tissue factors thromboplastins and
factor3 during injury causes a cascade activation of a
factor pathway that has a dominant role in the
hyperthrombinemic state in DIC.
2. Cytokines and the bacterial endotoxins are all triggers to
the formation of endothelial cell tissue factor.
3. In severe trauma also tissue phospholipids initiates the
Alteration of the physiological
There are 3 most common Anticoagulants in the body :
2. Active protein C
3. Tissue factor pathway inhibitor (TFPI)
In DIC :
1. Anti thrombin
2. Active protein C
• Consumption of the elaborated thrombin.
• Elastase release from neutrophils (seen in
case of septicemia and anoxic liver
Causes of decrease in
• Thrombomodulin(integral membrane
protein of endothelial cells) combines with
protein C to form active protein C.This is
done in activation of thrombomodulin by
• In case of liver injury and or a down
regulation thrombomodulin expression on
the vascular surface.
Causes of decrease in active
protein C levels
Impaired fibrinolysis at the onset of DIC:
1. PAI-1 a neurohumoral compound released from endothelial cells.
2. It suppresses fibrinolysis normally
3. In some DIC individuals , PAI -1gene mutation shown leading to
increased PAI-1 levels
Activation and liberation of inflammatory
cytokines in DIC :
Clinical features :
•Cyanosis and respiratory failure
•Convulsions and coma
•Oliguria and acute renal failure
•Sudden or progressive circulatory
failure and shock
•Bleeding , possibly from multiple
sites of body
SITES OF THROMBOSIS IN
DECREASING ORDER OF FREQUENCY
DIFFERENTIAL DIAGNOSIS :
1. Severe liver disease :lab
parameters won’t change
rapidly and presence of
consumption of clotting
factors or hyperfibrinolysis.
Lab investigations of DIC :
CBC and blood
• Decreased may
not be in acute
but in severe
al level rules
• PT Prolonged.
• PTT prolonged
• TT increased
And blood smear
International society on
system for diagnosis of
A score below 5 is suggestive
as a diagnosis but not the
definite; hence the test must