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1. Dr. Ayaz Lone

2. An acquired syndrome
characterized by the
intravascular activation of
coagulation with loss of
localization arising from
different causes.

3.  An acquired syndrome
characterized by
systemic intravascular
coagulation
 Coagulation is always the
initial event.
 Most morbidity and
mortality depends on
extent of intravascular
thrombosis
6
ThrombosisThrombosis
FibrinFibrin
Red Blood CellRed Blood Cell
PlateletPlatelet
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4.  Sepsis/ Severe infections
 Trauma
 Organ destruction
 Severe pancreatitis
 Malignancies
 Solid Tumors
 Leukaemias, Acute Promyelocytic
 Lymphoproliferative disorders
 Myeloproliferative syndromes

5.  Obstetrical Causes
 Amniotic fluid embolism
 Abruptio placenta
 Septic abortion
 Retained products of conception
 HELLP syndrome
 Severe toxic or immunological reactions
 Snake bites
 Transfusion reactions
 Transplant rejection
 Recreational drugs

6.  Massive blood loss with inadequate fluid
replacement therapy
 Severe hepatic failure
 Vascular abnormalities
 Severe burns

7.  Activation of Blood Coagulation
 Suppression of Physiologic Anticoagulant
Pathways
 Impaired Fibrinolysis
 Cytokines

8.  Activation of Blood Coagulation
 Tissue factor/factor VIIa mediated thrombin
generation via the extrinsic pathway
 complex activates factor IX and X
 TF
 endothelial cells
 monocytes
 Extravascular:
 lung
 kidney
 epithelial cells

9.  Suppression of Physiologic Anticoagulant
Pathways
 reduced antithrombin III levels
 reduced activity of the protein C-protein S
system
 Insufficient regulation of tissue factor activity by
tissue factor pathway inhibitor (TFPI)
 inhibits TF/FVIIa/Fxa complex activity

10.  Impaired Fibrinolysis
 relatively suppressed at time of maximal activation
of coagulation due to increased plasminogen
activator inhibitor type 1

11.  Cytokines
 IL-6, and IL-1 mediates coagulation activation in DIC
 TNF-
 mediates dysregulation of physiologic anticoagulant pathways and
fibrinolysis
 modulates IL-6 activity
 IL-10 may modulate the activation of coagulation
CoagulationInflamatio
n

13. SYSTEMIC
ACTIVATION OF
COAGULATION
Intravascula
r deposition
of fibrin
Depletion of
platelets and
coagulation
factors
Thrombosis of
small and
midsize vessels
Bleeding
Organ failure DEATH

14.  CBC
 Platelet count
 Peripheral Smear
 Coagulation Profile
 PT
 APTT
 Serum Fibrinogen

15.  Fibrinogen degradation products ( FDP’s)
 D-Dimers

16.  Fragments
 Schistocytes
 Paucity of platelets