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Concept
Disseminated intravascular coagulation
Summary
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body. As clotting factors and platelets are used up, bleeding may occur. This may include blood in the urine, blood in the stool, or bleeding into the skin. Complications may include organ failure.
Relatively common causes include sepsis, surgery, major trauma, cancer, and complications of pregnancy. Less common causes include snake bites, frostbite, and burns. There are two main types: acute (rapid onset) and chronic (slow onset). Diagnosis is typically based on blood tests. Findings may include low platelets, low fibrinogen, high INR, or high D-dimer.
Treatment is mainly directed towards the underlying condition. Other measures may include giving platelets, cryoprecipitate, or fresh frozen plasma. Evidence to support these treatments, however, is poor. Heparin may be useful in the slowly developing form. About 1% of people admitted to hospital are affected by the condition. In those with sepsis, rates are between 20% and 50%. The risk of death among those affected varies from 20% to 50%.
In DIC, the underlying cause usually leads to symptoms and signs, and DIC is discovered on laboratory testing. The onset of DIC can be sudden, as in endotoxic shock or amniotic fluid embolism, or it may be insidious and chronic, as in cancer. DIC can lead to multiorgan failure and widespread bleeding.
DIC can occur in the following conditions:
Cancer: solid tumors and blood cancers (particularly acute promyelocytic leukemia)
Complications of pregnancy: abruptio placentae, pre-eclampsia or eclampsia, amniotic fluid embolism, retained intrauterine fetal demise, septic abortion, postpartum hemorrhage
Massive tissue injury: trauma, burn, hyperthermia, rhabdomyolysis, surgery
Infection: bacterial (Gram-negative or Gram-positive), viral, fungal, or protozoan
Transfusion reaction: ABO incompatibility
Allergic or toxic reaction: snake venom
Hemangioma: Kasabach–Merritt syndrome
Aortic aneurysm
Liver disease, HELLP syndrome, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and malignant hypertension may mimic DIC but originate via other pathways.
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