"Widespread and inappropriate activation of the coagulation and fibrinolytic systems". Either bleeding (65%) or thrombosis predominates. This can be caused by a variety of reasons:
Most common cause of DIC, normally bleeding
10%–20% of patients with gram-neg sepsis have DIC
DIC is often chronic and compensated, normally thrombosis.
More likely to have bleeding than thrombosis
- Liver disease
May have chronic compensated DIC, or acute.
- Pregnancy complications
20% of patients with ARDS develop DIC; 20% of patients with DIC develop ARDS
- Transfusion reactions
Platelets low (or dropping) - sensitive, not specific
<100 correlates w/ severe DIC
D-dimer elevated - sensitive, not specific
RBCs fragmented (not specific)
Consider an LDH - it is released by red cells. It's a good indicator there are likely to be rbc fragments
Differential Diagnoses TTP-HUS: Patients usually have little or no prolongation of PT or PTT
Severe liver disease: d-dimer only mildly elevated
Treatment Treat underlying illness
Bloods ++++++ - haematology need them to work out what's going on. Include fibrinogen.
Haematology advice for cryoprecipitate, platelets, FFP, vitamin K, folate, heparin