Hematology and Oncology Book

DIC

  • Disseminated Intravascular Coagulation

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Disseminated Intravascular Coagulation

Aka: Disseminated Intravascular Coagulation, Disseminated Intravascular Coagulopathy, DIC
  1. Pathophysiology
    1. Intravascular fibrin deposition occludes small vessels
      1. Microemboli or thrombi form in vasculature
    2. Consumptive coagulopathy
      1. Widespread coagulation activation breaks down formed clot and depletes factors
      2. Results in both bleeding and clotting
      3. Factors depleted
        1. Platelets
        2. Antithrombin III
        3. Protein C
        4. Tissue factor pathway inhibitor
  2. Causes
    1. Infection
      1. Sepsis (most common)
      2. Gram NegativeSepsis
      3. Meningococcemia
      4. Rocky Mountain Spotted Fever
    2. Neoplastic disease
      1. Mucin-Secreting adenocarcinoma
      2. Promyelocytic Leukemia
      3. Prostate Cancer
      4. Lung Cancer
    3. Tissue Damage
      1. Trauma
      2. Surgery (e.g. Prostate Surgery)
      3. Heat Stroke
      4. Burn Injury
      5. Dissecting aneurysm
    4. Obstetrical Complication
      1. Abruptio Placentae
      2. Amniotic Fluid Embolism
      3. Retained fetal products on intrauterine fetal death
      4. Severe Preeclampsia
      5. HELLP Syndrome
      6. Acute Fatty Liver of Pregnancy
    5. Hemolytic disease
      1. Thrombotic Thrombocytopenic Purpura (TTP)
      2. Hemolytic Uremic Syndrome (HUS)
    6. Immunologic Disorders
      1. Immune complex disorders
      2. Allograft rejection
      3. Incompatible Blood Transfusion
      4. Anaphylaxis
    7. Metabolic
      1. Diabetic Ketoacidosis
    8. Miscellaneous
      1. Shock
      2. Snake Bite
      3. Cyanotic Congenital Heart Disease
      4. Fat embolism
      5. Severe liver disease
      6. Cavernous Hemangioma
  3. Signs
    1. Profuse bleeding from many sites
      1. Needle puncture site bleeding
      2. Mucosal bleeding
      3. Surgical incision or Laceration bleeding
      4. Multiple Bruises or Petechiae
    2. Thrombosis
      1. End organ ischemia or infarction
      2. Multi-system failure
    3. Associated conditions
      1. Acute Tubular Necrosis
      2. Adult Respiratory Distress Syndrome
      3. Purpura fulminans
  4. Labs: Initial
    1. Platelet Count <100,000/mm3
    2. Fibrinogen <300 mg/dl
    3. Fibrin split product >40 mg/dl
    4. Prothrombin Time (aPT) >14 seconds or INR increased
    5. Partial Thromboplastin Time (PTT) >40 seconds
    6. D-Dimer
      1. Early indicator of DIC in Preeclampsia
      2. Trofatter (1989) Obstet Gynecol 73:435-40 [PubMed]
  5. Labs: Monitoring (every 2 hours in DIC)
    1. Platelet Count
    2. Fibrinogen
  6. Management
    1. Supportive care
      1. ABC Management
      2. Cardiopulmonary support
    2. Treat underlying disorder
      1. Example: Delivery in pregnancy related DIC
      2. Example: Antibiotics in Sepsis
    3. Transfuse Blood Products as needed
      1. Packed Red Blood Cells
      2. Platelet Transfusion
        1. Goal Platelet Count >50,000/mm3
      3. Fresh Frozen Plasma (preferred over Cryoprecipitate) to supply Coagulation Factors, Fibrinogen
        1. Goal PT/INR and PTT <1.5x normal
      4. Avoid harmful measures
        1. Do not administer anti-fibrinolytic agents (e.g. Tranexamic Acid)
        2. Heparin use is controversial
    4. Heparin has been used in DIC (use is debated)
      1. Heparin continuous infusion at 300 to 500 IU/hour
  7. References
    1. Shinke and Ponce (2016) Crit Dec Emerg Med 30(8):13
    2. Levi (1999) N Engl J Med 341:586-92 [PubMed]

Disseminated Intravascular Coagulation (C0012739)

Definition (MSH) A disorder characterized by procoagulant substances entering the general circulation causing a systemic thrombotic process. The activation of the clotting mechanism may arise from any of a number of disorders. A majority of the patients manifest skin lesions, sometimes leading to PURPURA FULMINANS.
Definition (CHV) a disease where the blood clots throughout the body and increases the risk of bleeding
Definition (CHV) a disease where the blood clots throughout the body and increases the risk of bleeding
Definition (CHV) a disease where the blood clots throughout the body and increases the risk of bleeding
Definition (CHV) a disease where the blood clots throughout the body and increases the risk of bleeding
Definition (NCI_FDA) A disorder characterized by reduction in the elements involved in blood coagulation due to their utilization in widespread blood clotting within the vessels.
Definition (NCI) A pathological process where the blood starts to coagulate throughout the whole body. This depletes the body of its platelets and coagulation factors, and there is an increased risk of hemorrhage.
Definition (NCI_CTCAE) A disorder characterized by systemic pathological activation of blood clotting mechanisms which results in clot formation throughout the body. There is an increase in the risk of hemorrhage as the body is depleted of platelets and coagulation factors.
Definition (CSP) disorder characterized by reduction in the elements involved in blood coagulation due to their utilization in widespread blood clotting within the vessels; the activation of the clotting mechanism may arise from any of a number of disorders; in the late stages, it is marked by profuse hemorrhaging.
Concepts Disease or Syndrome (T047)
MSH D004211
ICD9 286.6
ICD10 D65
SnomedCT 267563002, 67406007
English Coagulation, Disseminated Intravascular, Coagulations, Disseminated Intravascular, Coagulations, Intravascular Disseminated, Coagulopathies, Consumption, Consumption Coagulopathies, Consumption Coagulopathy, DIC, Disseminated Coagulation, Intravascular, Disseminated Coagulations, Intravascular, Disseminated Intravascular Coagulation, Disseminated Intravascular Coagulations, Intravascular Coagulation, Disseminated, Intravascular Coagulations, Disseminated, Intravascular Disseminated Coagulation, Intravascular Disseminated Coagulations, Coagulation, Intravascular Disseminated, Coagulopathy, Consumption, Consumption coagulopathy, DISSEM. INTRAVASC. COAGULATION, DIC - Dissem intravas coagulat, Dissem intravascular coagulat, Disseminated intravascular coagulation [defibrination syndrome], INTRAVASC COAG DISSEM, DISSEM INTRAVASC COAG, DISSEM COAG INTRAVASC, INTRAVASC DISSEM COAG, COAG DISSEM INTRAVASC, DIC (disseminated intravascular coagulation), disseminated intravascular coagulation (DIC), disseminated intravascular coagulation (DIC) (diagnosis), defibrination syndrome, defibrination syndrome (diagnosis), Consumptive Coagulopathy, Dissem. intravasc. coagulation, Disseminated intravacular coagulation, Disseminated Intravascular Coagulation [Disease/Finding], consumptive coagulopathy, Dissemin. intravascular coag., DIC, DISSEMINATED INTRAVASCULAR COAGULATION, DISSEMINATED INTRAVASCULAR COAGULATION (DIC), COAGULATION (DIC), DISSEMINATED INTRAVASCULAR, INTRAVASCULAR COAGULATION (DIC), DISSEMINATED, DISSEMINATED INTRAVASCULAR COAGULATION, Defibrination syndrome, Disseminated intravascular coagulation, Consumptive coagulopathy, DIC syndrome, Hemorrhagic fibrinogenolysis, DIC - Disseminated intravascular coagulation, Haemorrhagic fibrinogenolysis, Consumptive thrombohaemorrhagic disorder, Consumptive thrombohemorrhagic disorder, Disseminated intravascular coagulation (disorder), consumption coagulopathy, coagulopathy; consumption, defibrination; syndrome, defibrination, fibrinogenolysis; hemorrhage, hemorrhage; fibrinogenolysis, syndrome; defibrination, Consumptive thrombohemorrhagic disorder, NOS, Diffuse or disseminated intravascular coagulation, disseminated intravascular coagulation, Disseminated intravascul coag
Dutch defibrinatiesyndroom, DIC, consumptiecoagulopathie, verbruikscoagulapathie, uitgezaaide intravasculaire coagulatie, bloeding; fibrinogenolyse, coagulopathie; verbruiks, defibrinatie; syndroom, fibrinogenolyse; bloeding, syndroom; defibrinatie, Gedissemineerde intravasculaire stolling [defibrinatiesyndroom], uitgezaaide intravasculaire stolling, Coagulopathie, intravasculaire, Consumptiecoagulopathie, Gedissemineerde intravasale stolling, Intravasale stolling, gedissemineerde, Stolling, gedissemineerde intravasale, Verbruikscoagulopathie
French CID, Coagulation intravasc. disséminée, COAGULATION INTRAVASC. DISSEMINEE, CIVD, Coagulation intravasculaire disséminée, Coagulopathie de consommation, Coagulopathie intravasculaire disséminée, Syndrome de défibrination
German dissem. Intravask. Gerinnung, Defibrinationssyndrom, DIC, DIVK, Disseminierte intravasale Gerinnung [Defibrinationssyndrom], KOAGULATION DISSEMINIERT INTRAVAS, disseminierte intravaskulaere Gerinnung, Disseminierte intravasale Gerinnung, Verbrauchskoagulopathie
Italian CID, Sindrome da defibrinazione, Coagulopatia da consumo, Coagulazione intravascolare disseminata
Portuguese Síndrome de desfibrinação, Coagulopatia de consumo, CIVD, COAGULACAO INTRAVASCULAR DISSEMIN, Coagulação intravascular disseminada, Coagulação Intravascular Disseminada, Coagulopatia de Consumo
Spanish Síndrome de desfibrinación, Coagulopatía por consumo, Coagulopatía de consumo, COAGULACION INTRAVASC. DISEMINADA, CID, coagulación intravascular diseminada (trastorno), coagulación intravascular diseminada, coagulopatía por consumo, fibrinogenólisis hemorrágica, síndrome de desfibrinación, Coagulación intravascular diseminada, Coagulación Intravascular Diseminada, Coagulopatía de Consunción
Japanese 脱線維素症候群, DIC, ショウヒセイギョウコショウガイ, ハシュセイケッカンナイギョウコ, DIC, ダツセンイソショウコウグン, 汎発性血管内凝固, 汎発性血管内血液凝固症, 播種性血管内凝固, 播種性血管内凝固症, 播種性血管内血液凝固症候群, 広汎性血管内血液凝固, 全身性血管内凝固, 播種性血管内凝固症候群, 播種性血管内血液凝固, 消費性凝固障害, 広汎性血管内凝固
Swedish Disseminerad intravasal koagulation
Czech diseminovaná intravaskulární koagulace, DIC, Diseminovaná intravaskulární koagulace, Konzumpční koagulopatie, Disem. inravask. koagulace, Defibrinační syndrom
Finnish DIC-oireyhtymä
Russian KOAGULOPATIIA POTREBLENIIA, TROMBOGEMORRAGICHESKII SINDROM, DVS-SINDROM, VNUTRISOSUDISTAIA KOAGULIATSIIA DISSEMINIROVANNAIA, DEFIBRINATSII SINDROM, ВНУТРИСОСУДИСТАЯ КОАГУЛЯЦИЯ ДИССЕМИНИРОВАННАЯ, ДВС-СИНДРОМ, ДЕФИБРИНАЦИИ СИНДРОМ, КОАГУЛОПАТИЯ ПОТРЕБЛЕНИЯ, ТРОМБОГЕМОРРАГИЧЕСКИЙ СИНДРОМ
Korean 파종성 혈관내 응고[탈섬유소증후군]
Polish Koagulopatia ze zużycia, Krzepnięcie wewnątrznaczyniowe rozsiane, DIC, Zespół defibrynacji, Zespół rozsianego wykrzepiania wewnątrznaczyniowego, Zespół wykrzepiania rozsianego
Hungarian Defibrination syndroma, Dissem. intravasc. alvadás, Consumptios coagulopathia, Consuptiós coagulopathia, disseminált intravascularis coagulatio, DIC, Disseminált intravacularis alvadás
Norwegian Disseminert intravaskulær koagulasjon, Forbrukskoagulopati, DIC, Defibrineringssyndrom
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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