Adult Emergency Medicine: DIC

Wednesday, 30 April 2014

DIC

"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:

- Infection
        Most common cause of DIC, normally bleeding
        10%–20% of patients with gram-neg sepsis have DIC
- Carcinoma
        DIC is often chronic and compensated, normally thrombosis.
- Leukemia
        More likely to have bleeding than thrombosis
- Trauma
- Liver disease
        May have chronic compensated DIC, or acute.
- Pregnancy complications
- Envenomation
- ARDS
        20% of patients with ARDS develop DIC; 20% of patients with DIC develop ARDS
- Transfusion reactions

Diagnoses
Acute DIC
        Platelets low (or dropping) - sensitive, not specific
        PT prolonged
        Fibrinogen low
            <100 correlates w/ severe DIC
        PTT prolonged
        D-dimer elevated - sensitive, not specific
        RBCs fragmented (not specific)

Chronic DIC
        FDP: Elevated
        D-dimer: Elevated
        Platelet: Variable
        Fibrinogen: Normal-elevated
        PT: Normal
        PTT: Normal
        RBCs: Fragmented
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
    Heparin-induced thrombocytopenia

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