Disseminated intravascular coagulation

Disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a complex systemic disorder characterized by both widespread clotting and bleeding. It typically arises as a secondary condition in response to an underlying disease or trauma, disrupting the balance between the body's clotting and anti-clotting mechanisms.

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DIC With Microangiopathic Hemolytic Anemia

Pathophysiology

In DIC, the normal hemostatic balance is disrupted, leading to excessive clotting and, paradoxically, a risk of severe bleeding. The pathophysiological process begins with the widespread activation of the coagulation cascade, leading to the formation of microthrombi in the blood vessels. This over-activation depletes the body's reserves of clotting factors and platelets, leading to a coagulopathic state that can result in hemorrhage.

Causes and Risk Factors

DIC can be triggered by a wide range of conditions, most commonly sepsis Sepsis, severe trauma, malignancies, obstetric complications, and severe burns. Some individuals may be at a higher risk for developing DIC, including those with severe infections, extensive tissue damage, or certain types of cancer.

Clinical Manifestations

The signs and symptoms of DIC can vary widely, depending on the underlying cause and the balance between clotting and bleeding. Symptoms may include bleeding from multiple sites, thrombosis, end-organ damage, and in severe cases, shock or multiorgan failure.

Diagnosis

The diagnosis of DIC is made through a combination of clinical findings and laboratory tests. Lab tests typically show prolonged clotting times, low platelet counts, increased levels of fibrin degradation products, and decreased levels of clotting factors.

Management and Treatment

Management of DIC primarily involves treating the underlying cause. Supportive care, such as transfusion of blood products, may be necessary. In some cases, drugs that inhibit clot formation, such as heparin, may be used, although this is controversial and depends on the patient's individual clinical situation.

Prognosis

The prognosis of DIC depends largely on the underlying cause and the patient's overall clinical condition. If the triggering condition can be effectively treated, the DIC often resolves. However, in severe cases or when the underlying cause cannot be controlled, DIC can contribute to significant morbidity and mortality.

References

• Wada, H., Thachil, J., Di Nisio, M., et al. (2013). "Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines". Journal of Thrombosis and Haemostasis.
• Levi, M., Toh, CH., Thachil, J., Watson, HG. (2009). "Guidelines for the diagnosis and management of disseminated intravascular coagulation". British Journal of Haematology.
• Levi, M. (2018). "Disseminated Intravascular Coagulation". Critical Care Medicine.

External Links

• Mayo Clinic - Disseminated intravascular coagulation (DIC)
• MedlinePlus - Disseminated intravascular coagulation

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