Disseminated intravascular coagulation (DIC)

Definition

Disseminated intravascular coagulation (DIC) is a serious disorder in which the proteins that control blood clotting become abnormally active.

Alternative Names

Consumption coagulopathy

Causes, incidence, and risk factors

Normally, when you are injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, in persons with DIC, these proteins become abnormally active.

Small blood clots form within the blood vessels. Some of these clots can clog up the vessels and cut off blood supply to various organs such as the liver or kidney. These organs will then stop functioning. Over time, the clotting proteins become "used up." When this happens, the person is then at risk for serious bleeding from even a minor injury.

This disorder can result in clots or, more often, in bleeding. The bleeding can be severe.

Risk factors for DIC include:

• Blood transfusion reaction
• Cancer, including leukemia
• Infection in the blood by bacteria or fungus
• Pregnancy complications (such as retained placenta after delivery)
• Recent surgery or anesthesia
• Sepsis (an overwhelming infection)
• Severe liver disease
• Severe tissue injury (as in burns and head injury)

Symptoms

• Bleeding, possibly from multiple sites in the body
• Blood clots
• Drop in blood pressure
• Sudden bruising

Signs and tests

The following tests may be done:

• Examination of a blood sample under a microscope
• Fibrin degradation products - high
• Partial thromboplastin time (PTT) - high
• Platelet count - low
• Prothrombin time (PT) - high
• Serum fibrinogen - low

Treatment

The goal is to determine and treat the underlying cause of DIC.

Blood clotting factors will be replaced with plasma transfusions. Heparin, a medication used to prevent clotting, is sometimes used also.

Expectations (prognosis)

The outcome depends on what is causing the disorder.

Complications

• Lack of blood flow to arms, legs, or vital organs
• Severe bleeding
• Stroke

Calling your health care provider

Go to the emergency room or call 911 if you have bleeding that won't stop.

Prevention

Get prompt treatment for conditions known to bring on this disorder.

References

Levi M. Disseminated intravascular coagulation: What's new? Crit Care Clin. Jul 2005; 21(3): 449-67.

DeLoughery TG. Critical care clotting catastrophies. Crit Care Clin. Jul 2005; 21(3): 531-62.

Gando S. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. Mar 2006; 34(3): 625-31.