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Disseminated Intravascular Coagulation (DIC)

Eric Singhi


Background

  • Concurrent activation of the coagulation pathway and fibrinolytic pathway
  • Consumption of platelets, fibrin, and coagulation factors fibrinolysis end organ damage and hemolysis
  • Etiologies:
    • Infection/Sepsis, Liver disease, Pancreatitis, Trauma
    • Malignancies: mucin-secreting pancreatic/gastric adenocarcinoma, brain tumors, prostate cancer, all acute leukemias, acute promyelocytic leukemia
    • Obstetric complications (i.e. preeclampsia/eclampsia, placental abruption)
    • Acute hemolytic transfusion reaction (i.e. ABO incompatible transfusion)

Evaluation

  • Exam: petechiae, bleeding (mucosal, IV site, surgical wound site, hematuria), ecchymoses, thrombosis (i.e. cold, pulseless extremities)
  • CBC, PT/INR, aPTT, Fibrinogen, D-Dimer, Peripheral Blood Smear
  • “DIC labs” = q6h fibrinogen, PT/INR, aPTT (space out when lower risk)
  • Findings suggestive of DIC: thrombocytopenia, prolonged aPTT and PT/INR, hypofibrinogenemia, elevated D-dimer, fibrin degradation products, schistocytes

Management

  • Treat the underlying cause!
  • Vitamin K for INR > 1.7 or bleeding
  • Hypofibrinogenemia treatment: Cryoprecipitate 5-10 units if fibrinogen < 100
  • Thrombocytopenia treatment: plt transfusion as normally indicated
  • DVT ppx if not bleeding and plt > 50
  • VTE: anticoagulation if plt > 50 and no massive bleeding

Last update: 2022-06-25 02:05:01