2. Meaning
DIC is an acquired thrombotic and
hemorrhagic syndrome characterized
by abnormal activation of the clotting
cascade and accelerated fibrinolysis.
This results in widespread clotting in
small vessels with consumption of
clotting factors and platelets, so that
bleeding and thrombosis occur
simultaneously.
3. Etiology
A syndrome arising with an underlying
disorder or event:
◦ Overwhelming infections, particularly
bacterial sepsis.
◦ Obstetric complications: abruptio
placentae, eclampsia, amniotic fluid
embolism, retention of dead fetus.
4. ◦ Massive tissue injury: burns, trauma,
fractures, major surgery, fat
embolism, organ destruction (eg,
severe pancreatitis, hepatic failure).
◦ Vascular and circulatory collapse,
shock.
7. Clinical Manifestations
Signs of abnormal clotting:
◦ Coolness and mottling of extremities.
◦ Acrocyanosis (cold, mottled extremities
with clear demarcation from normal
tissue).
◦ Dyspnea, adventitious breath sounds.
◦ Altered mental status.
◦ Acute renal failure.
◦ Pain (eg, related to bowel infarction).
8. Signs of abnormal bleeding:
◦ Oozing, bleeding from sites of
procedures, I.V. catheter insertion
sites, suture lines, mucous
membranes, orifices.
◦ Internal bleeding leading to changes
in vital organ function, altered vital
signs.
9. Diagnostic Evaluation
Platelet count diminished.
PT, PTT, and thrombin time prolonged.
Fibrinogen decreased level.
Fibrin split (degradation) products
increased level.
D-dimer fibrin degradation product
increased level.
Antithrombin III decreased level.
Protein C decreased level.
11. Supportive measures including fluid
replacement, oxygenation,
maintenance of BP and renal
perfusion.
Heparin therapy (controversial) inhibits
clotting component of DIC.
12. Complications
Thromboembolic: pulmonary
embolism; cerebral, myocardial,
splenic, or bowel infarction; acute
renal failure; tissue necrosis or
gangrene.
Hemorrhagic: cerebral hemorrhage is
most common cause of death in DIC.
