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Disseminated Intravascular Coagulopathy (DIC)

Disseminated Intravascular Coagulopathy (DIC)
September 17, 2020HematologyLab Tests

Sample

  • Collect the blood for PT and PTT.
  • Immediately do assay for clotting factors.

Purpose of the test (Indications)

  1. To exclude the septicemia.
  2. Amniotic fluid embolism.
  3. Retention of the dead fetus.
  4. Malignant neoplasia.
  5. In liver cirrhosis.
  6. Extensive surgery especially on the liver.
  7. Severe burn.
  8. Extensive trauma.
  9. After blood transfusion reaction.

Pathophysiology

  1. In DIC there is inappropriate activation of the clotting system.
  2. This will lead to systemic or localized fibrin clot formation.
  3. Due to increased clotting, there is sludging and excessive bleeding because of the consumption of platelets + clotting factors.
    1. There is increased coagulation which overcomes the inhibitory mechanism.
    2. This will leads to thrombus formation at the site and in the microcirculation leading to the hemorrhagic syndrome.
    3. This hemorrhagic syndrome is called DIC, or defibrination syndrome or consumptive coagulopathy.
Disseminated intravascular coagulopathy (DIC)

Disseminated intravascular coagulopathy (DIC)

Mechanism of DIC

Mechanism of DIC

  1. The fibrinolytic system is activated breaks the clots + fibrin.
  2. Fibrinolysis leads to FDP (Fibrin degradation products).
  3. FDPs increase bleeding tendency.
DIC and FDPs

DIC and FDPs

  1. Intravascular clots lead to microvascular occlusion leads to injury to the organs.
  2. There may be hemolysis of RBCs by passing through these vessels.
DIC complications

DIC complications

  1. DIC may be:
    1. Acute DIC (Acute hemorrhagic DIC).
    2. Chronic DIC (Subacute chronic DIC).

Workup of a patient with DIC:

  • The lab. finding of the DIC reflects direct or indirect excess of thrombin and plasmin generation.
  • No single test is diagnostic.
  • Indirect tests are the lake for thrombin action includes PT, APTT, and thrombin/reptilase clotting test.
  • The confirmatory test is the demonstration of the fibrin deposition in the biopsy blood vessels which are involved.
  1. The following tests are advised to diagnose DIC
    1. Platelet count. There is thrombocytopenia.
      1. There is an increased plasma level of platelets specific protein (β-thromboglobulin).
      2. Platelet factor 4.
    2. Prothrombin time (PT).
    3. Partial thromboplastin time (PTT).
    4. Coagulation factor assay.
    5. Fibrinogen degradation products (FDP).
    6. Fibrinogen.
    7. d-dimer.
    8. Prothrombin fragments.
    9. The peripheral blood smear shows schistocytes.
  2. Immediately perform the following test and that will diagnose the DIC.
    1. PT.
    2. PTT.
    3. Platelet count.
    4. Bleeding time

Causes of DIC:

  1. Bacterial Septicemia.
  2. Retention of a dead fetus.
  3. Amniotic fluid embolism.
  4. Liver diseases.
  5. malignant diseases.
  6. Extensive surgery on the liver or prostate.
  7. Heart bypass surgery.
  8. Extensive trauma.
  9. Severe burns.
  10. Transfusion reaction.

Clinical conditions associated with DIC:

Due to Thromboplastin release – Factor VII activation:
  1. Placental abruption.
  2. Sepsis.
  3. Promyelocytic leukemia.
  4. Retained dead fetus syndrome.
  5. Amniotic fluid embolus.
  6. Cardiopulmonary bypass surgery.
  7. Acute intravascular hemolysis.
  8. Adenocarcinoma (mucin-producing).
  9. Trauma.

Due to Factor X / II activation:

  1. Acute pancreatitis.
  2. Snake venom.
  3. Fat emboli syndrome.
  4. Liver diseases.

Due to endothelial cells damage –  Factor XII activation:

  1. Liver diseases.
  2. Intravascular hemolysis.
  3. Immune complex diseases.
  4. Vasculitis.
  5. Burns.
  6. Anoxia.
  7. Acidosis.
  8. Heatstroke.
The table shows the findings of the various test in DIC:
Tests
Outcome
Bleeding time Increased
Platelet count Decreased
Partial thromboplastin time Increased
Prothrombin time Increased
FDPs Increased
Fibrinogen Decreased
d-Dimer Increased
Prothrombin fragments Increased
Coagulation factors Decreased I, II, V, VIII, X,  XIII
Peripheral smear Damaged RBCs
Laboratory diagnosis of Acute DIC:
    Lab Test                                    DIC                    
PT usually prolonged
PTT Usually prolonged
Fibrinogen contents usually decreased
Confirmatory test
FDP Positive more than 40 µg/mL
D-Dimer Positive

Table showing different between acute and Chronic DIC:
Lab Tests
Acute DIC
Chronic DIC
PT prolonged normal
PTT prolonged normal
Fibrinogen usually decreased usually normal
D-dimer positive positive
FDP positive >40  µg/mL positive <40  µg/mL
Normal Values Seen in the normal person:
  • Platelets are normal.
  • PT and PTT normal.
  • FDPs are negative.

Treatment

Treatment is two folds:

  1. Removal of the underlying pathologic cause.
  2. Maintain the blood volume and hemostatic function.
    1. There is a transfusion of the packed red blood cells.
    2. Give fresh frozen plasma.
    3. Give platelets concentrate.

Possible References Used
Go Back to Hematology

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