Overview

Disseminated Intravascular Coagulation (DIC) is a serious medical condition characterized by widespread activation of the body’s blood clotting mechanisms. This leads to the formation of small blood clots throughout the bloodstream, which can block small blood vessels and reduce blood flow to organs. Paradoxically, because clotting factors and platelets are consumed rapidly, DIC can also cause severe bleeding. It is not a disease on its own but a complication of underlying conditions such as severe infections, trauma, or cancer. DIC is considered a medical emergency and requires prompt diagnosis and treatment to prevent life-threatening complications.

Causes

DIC develops as a secondary complication in response to various severe illnesses or triggers. The most common causes include:

• Sepsis: Severe bacterial, viral, or fungal infections can trigger widespread inflammation and clotting abnormalities.
• Severe Trauma: Major injuries, especially those involving significant tissue damage like crush injuries or burns, can precipitate DIC.
• Cancer: Certain cancers, particularly leukemia, pancreatic, and prostate cancer, are associated with chronic forms of DIC.
• Obstetric Complications: Conditions such as placental abruption, amniotic fluid embolism, and preeclampsia can lead to DIC during pregnancy or childbirth.
• Major Surgery: Complicated surgical procedures, especially involving massive transfusions or trauma, may induce DIC.
• Severe Allergic Reactions: Anaphylaxis can occasionally trigger coagulation abnormalities.
• Snake Venom: Certain snakebites introduce venom that can disrupt the normal clotting cascade, leading to DIC.

Symptoms

The symptoms of DIC vary depending on whether clotting or bleeding is predominant, but many patients experience both simultaneously. Common signs and symptoms include:

• Bleeding: Spontaneous bruising, bleeding gums, nosebleeds, or excessive bleeding from minor cuts.
• Petechiae: Small, pinpoint red or purple spots on the skin caused by minor bleeding under the skin.
• Prolonged Bleeding Time: Difficulty stopping bleeding after injuries or medical procedures.
• Blood in Urine or Stool: Hematuria (blood in urine) or melena (black, tarry stools) may occur.
• Organ Dysfunction: Clots can block blood flow to organs, leading to kidney failure, liver dysfunction, lung problems, or neurological symptoms such as confusion or seizures.
• Shock: Severe cases can cause low blood pressure, rapid heart rate, and multi-organ failure.
• Skin Changes: Cyanosis (bluish skin), gangrene, or skin necrosis in areas with reduced blood flow.

Diagnosis

Diagnosing DIC involves a combination of clinical assessment and laboratory tests aimed at identifying both clotting and bleeding abnormalities:

• Clinical History: Identification of an underlying trigger such as infection, trauma, or malignancy is crucial.
• Complete Blood Count (CBC): Typically shows low platelet count (thrombocytopenia).
• Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT): These clotting times are usually prolonged in DIC.
• Fibrinogen Levels: Often decreased because fibrinogen is consumed during clot formation.
• D-Dimer Test: Elevated D-dimer levels reflect increased clot breakdown, supporting the diagnosis.
• Peripheral Blood Smear: May show fragmented red blood cells (schistocytes) due to clot-related damage to red blood cells.
• Scoring Systems: Tools like the ISTH DIC scoring system may be used to confirm diagnosis based on lab results.

Treatment

Treatment of DIC focuses on addressing the underlying cause while supporting the body's coagulation system. Main treatment strategies include:

• Management of Underlying Condition: Prompt treatment of sepsis, trauma, or cancer is critical to controlling DIC.
• Supportive Care: Monitoring in intensive care settings with close observation of vital signs and laboratory values.
• Blood Product Transfusions: Platelet transfusions, fresh frozen plasma, and cryoprecipitate may be used to replace depleted clotting factors and platelets in cases with significant bleeding.
• Anticoagulant Therapy: In some cases, low-dose heparin may be used to prevent clot formation, especially when thrombosis dominates the clinical picture.
• Oxygen Therapy: Supplemental oxygen or mechanical ventilation may be required if lung function is compromised.
• Organ Support: Dialysis for kidney failure or vasopressor medications for shock may be necessary.

Prognosis

The prognosis of DIC depends on the severity of the condition and how quickly the underlying cause is addressed:

• Acute DIC: When DIC develops rapidly, it can be life-threatening with high mortality rates, particularly if not treated promptly.
• Chronic DIC: Seen in cancer patients, it tends to progress more slowly and may be managed on a long-term basis.
• Reversibility: In cases where the underlying cause is treatable (e.g., infections), DIC can often be reversed with appropriate care.
• Complications: Severe cases may lead to irreversible organ damage, amputations (due to gangrene), or death.
• Survival Rates: Survival improves significantly with early diagnosis, aggressive treatment, and management in specialized care settings.

DIC is a critical condition that requires immediate medical attention. Early recognition, treatment of the underlying cause, and supportive care are key to improving outcomes and reducing the risk of serious complications.