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Disseminated Intravascular Coagulation

Acquired Purpura Fulminans


Presentation

The following organ systems heralds the following manifestation during a disseminated intravascular coagulation:

  • Heart: Chest pain may be seen due to the presence of clot formation in the heart where a heart attack is also possible.
  • Lungs: Shortness of breath is seen if clots are present in the lungs.
  • Kidney and other organs: Clots present here can result in kidney failure or failure of the organ where the clot is present.
  • Brain: Blood clots in the brain will lead to into stroke. Headache, paralysis, dizziness, changes in speech, and alike are observable in stroke patients. Severe bouts of headaches and double vision may be caused by bleeding in the brain.
  • Limbs: Swelling, pain, redness and warmth in the limb where a blood clot is present.
  • Internal bleeding: Blood in urine and in the stools.
  • External bleeding: Bleeding under the skin or in body cavities or at sites of intravenous injection.
Easy Bruising
  • Other symptoms are: blood clots decreased blood pressure easy bruising rectal or vaginal bleeding red dots on the surface of the skin ( petechiae ) If you have cancer, DIC generally begins slowly, and clotting in the veins is more common than excessive[healthline.com]
Cough
  • Clinical history can include epistaxis, gingival bleeding, haematuria, oliguria, cough, dyspnoea, fever, delirium, and coma.[bestpractice.bmj.com]
  • You cough up blood. Your arm or leg feels warm, tender, and painful. It may also look swollen and red.[drugs.com]
  • Symptoms of Disseminated Intravascular Coagulation If you are affected by disseminated intravascular coagulation, some of the following symptoms may be experienced; Symptoms of infection – fevers , cough , shortness of breath, pain , rash, behaviour changes[myvmc.com]
  • After treatment with fresh frozen plasma and fenbendazole, coagulation parameters improved and the cough resolved.[sat.gstsvs.ch]
  • […] organ dysfunction caused by blood clots blocking blood flow and oxygen to organs such as the liver and kidney, leading to liver and kidney failure Blackening of the skin caused by blockage from blood clots and poor blood flow to the skin Chest pain, coughing[labtestsonline.org]
Dyspnea
  • A 66-year-old woman presented to an urgent care clinic for 2 to 3 weeks of general malaise, nausea/vomiting, night sweats, and dyspnea.[ncbi.nlm.nih.gov]
  • , rales Pulmonary thromboembolism : dyspnea , chest pain , hemoptysis Deep vein thrombosis : lower limb edema Neurological dysfunction: altered mental status , stroke Purpura fulminans: DIC with extensive skin necrosis Waterhouse Friderichsen syndrome[amboss.com]
  • […] red, pinpointlike dots (petechiae) Vomiting of blood Bloody or black stools Blood in the urine Vaginal bleeding Unexplained bruises Severe abdominal or back pain Seizures or loss of consciousness in advanced cases (rare) Nausea Difficulty breathing (dyspnea[healthcommunities.com]
  • Amniotic fluid embolism, sepsis, and trauma can lead to dyspnea and acute respiratory distress syndrome (ARDS).[clinicaladvisor.com]
Hemoptysis
  • […] hematochezia Collection of blood in body cavities: features of hemoperitoneum , hemothorax Thrombotic manifestations Acute renal failure : oliguria Hepatic dysfunction : jaundice ARDS : dyspnea , rales Pulmonary thromboembolism : dyspnea , chest pain , hemoptysis[amboss.com]
  • Assess the patient’s skin for any petechiae, ecchymoses, hematoma formation, epistaxis, bleeding from wounds, vaginal bleeding in the labor or postpartum patient, hematuria, conjunctival hemorrhage, and hemoptysis.[medical-dictionary.thefreedictionary.com]
Anemia
  • And, early diagnosis with appropriate intervention is important because mortality from ES is known to be greater than that of isolated immune hemolytic anemia and probably worse in the presence of DIC.[ncbi.nlm.nih.gov]
  • DIT results in TTP-like syndrome with hematologic phenotype of consumptive thrombocytopenia, microangiopathic hemolytic anemia, and multiorgan dysfunction syndrome.[ncbi.nlm.nih.gov]
  • Both recipients experienced clinically significant hemolytic anemia, which typically occurs at a very low frequency. These cases illustrate a potential concern for the use of tranexamic acid in deceased kidney donors with DIC.[ncbi.nlm.nih.gov]
  • In light of developing fluctuant subgaleal fluid associated with pallor, anemia, metabolic acidosis, and respiratory distress, immediate blood transfusion is warranted. In the presence of DIC, transfusion of FFP is beneficial.[ncbi.nlm.nih.gov]
  • Grade 3 adverse effects included neutropenia, anemia, hyponatremia, catheter-related infection and diarrhea (maximum: 2 patients each).[ncbi.nlm.nih.gov]
Fever
  • There was no other explanation for the fever and rash, including infection, malignancy, and collagenosis.[ncbi.nlm.nih.gov]
  • Some patients with DIC and fever can continue conservative management of placenta percreta, although careful examination and monitoring are needed.[ncbi.nlm.nih.gov]
  • Delirium • diarrhea • fever • hypertension • hyperventilation • tachycardia • weight loss. -. -. Endocrinology and Metabolic. Unusual clinical course.[ncbi.nlm.nih.gov]
  • Five days after a contrasted abdominal computerized tomography (CT) scan, he exhibited high fever and disturbance of consciousness.[ncbi.nlm.nih.gov]
  • Although the coagulopathy improved after fresh-frozen plasma and antithrombin-III administration, the fever persisted despite two rounds of intravenous immunoglobulin, along with intravenous methylprednisolone pulse therapy and infliximab administration[ncbi.nlm.nih.gov]
HELLP Syndrome
  • Nevertheless, it has been suggested that in most cases these women also had a HELLP syndrome and that the occurrence of DIC in women who had only preeclampsia without manifestations of the HELLP syndrome is rare.[ncbi.nlm.nih.gov]
  • syndrome; (4) retained stillbirth; (5) sepsis; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy.[ncbi.nlm.nih.gov]
  • syndrome Amniotic fluid embolism Disseminated Intravascular Coagulation Injuries Untreated, DIC can cause serious and potentially fatal injuries, including: Hemorrhage (excessive bleeding) Shock Maternal death Fetal death Preventing and Treating DIC[birthinjuryjustice.org]
  • HELLP syndrome: HELLP syndrome: Hemolysis, Elevated Liver enzymes, Low platelet count Syndrome. AFLP: Acute Fatty Liver pregnancy. (DOCX) Author Contributions Conceptualization: MJ FF. Data curation: MJ. Formal analysis: MJ FF AD. Investigation: MJ.[journals.plos.org]
  • Obstetric causes include complications such as amniotic fluid embolism , pre-eclampsia and eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets ), placental abruption and placenta praevia, intrauterine infection and death of[cochrane.org]
Malaise
  • A 66-year-old woman presented to an urgent care clinic for 2 to 3 weeks of general malaise, nausea/vomiting, night sweats, and dyspnea.[ncbi.nlm.nih.gov]
  • Acute DIC Chronic DIC Multiple bleeding sites Bruising of skin, mucous membranes Internal bleeding Lack of blood supply to tissues ( ischaemia ) Sudden onset of high fever , severe general malaise , and extensive purpura of the extremities Petechiae ,[dermnetnz.org]
Patient Appears Acutely Ill
  • On physical examination, the patient appeared acutely ill, but her heart sounds were normal. A neurologic examination revealed no abnormalities. Laboratory test results are shown in Table 1 .[kjim.org]
Hematemesis
  • References: [3] [4] Clinical features Bleeding manifestations Petechiae , purpura , ecchymoses Oozing of blood from surgical wounds, intravenous lines Hematuria Hematemesis , hematochezia Collection of blood in body cavities: features of hemoperitoneum[amboss.com]
Bleeding Gums
  • Signs and symptoms that appear gradually are prolonged bleeding from a venipuncture site, bleeding gums, nosebleeds, and bruising easily as well as the presence of minute, pinpoint red spots caused by bleeding under the layer of the skin.[encyclopedia.com]
Tachycardia
  • Delirium • diarrhea • fever • hypertension • hyperventilation • tachycardia • weight loss. -. -. Endocrinology and Metabolic. Unusual clinical course.[ncbi.nlm.nih.gov]
  • Ablation of ventricular tachycardia. Herzschrittmachertherap Elektrophysiol 2007; 18:225–233. Hindricks G.[innovationsincrm.com]
  • During this exploration, ECG revealed a broad complex tachycardia with no palpable pulse confirming cardiac arrest likely secondary to hypovolaemia and/or hyperkalaemia.[bjmp.org]
  • Hemorrhages from incisions or catheter or injection sites, GI bleeding, hematuria, pulmonary edema, pulmonary embolism, progressive hypotension, tachycardia, absence of peripheral pulses, restlessness, convulsions, or coma may occur.[medical-dictionary.thefreedictionary.com]
Acrocyanosis
  • Consider heparin (300-500 U/hr) for DIC manifested by thrombosis or acrocyanosis in the absence of active bleeding. 5 Anti-fibrinolytics (tranexamic acid and ε-amioncaproic acid) are generally contraindicated, except in the setting of life-threatening[emdocs.net]
Purpura
  • Herein, we report a case of pneumococcal sepsis-induced purpura fulminans limited to the skin in an asplenic adult patient without the development disseminated intravascular coagulation.[ncbi.nlm.nih.gov]
  • The DIC was rapidly improved; however, the purpura and coagulopathy recurred after two months, and repeated rhsTM treatments were required.[ncbi.nlm.nih.gov]
  • A 78-year-old woman was admitted to our hospital complaining of anorexia and purpura of the extremities. She presented with prominent peripheral eosinophilia and disseminated intravascular coagulation (DIC).[ncbi.nlm.nih.gov]
  • We report on 3 male neonates with hereditary ADAMTS13 deficiency (Upshaw Schulman syndrome, USS), the inherited form of thrombotic thrombocytopenic purpura (TTP). 2 presented shortly after birth with thrombocytopenia followed by microangiopathic Coombs-negative[ncbi.nlm.nih.gov]
  • […] coagulopathy Diffuse or disseminated intravascular coagulation [DIC] Fibrinolytic hemorrhage, acquired Fibrinolytic purpura Purpura fulminans Type 1 Excludes Type 1 Excludes Help A type 1 excludes note is a pure excludes.[icd10data.com]
Petechiae
  • Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days. Laboratory data and symptoms on admission indicated DIC.[ncbi.nlm.nih.gov]
  • Physical examination may reveal petechiae, ecchymosis, gangrene, mental disorientation, hypoxia, hypotension, and GI bleeding.[bestpractice.bmj.com]
  • Clinical Symptoms These are noted due to spontaneous primary bleeding, including petechiae, ecchymoses, mucosal bleeding or secondary bleeding into body cavities e.g. haemoabdomen .[en.wikivet.net]
  • Symptoms of Disseminated Intravascular Coagulation Abnormal bleeding from anywhere in the body, possibly at several sites at once Tiny, red, pinpointlike dots (petechiae) Vomiting of blood Bloody or black stools Blood in the urine Vaginal bleeding Unexplained[healthcommunities.com]
Epistaxis
  • Clinical history can include epistaxis, gingival bleeding, haematuria, oliguria, cough, dyspnoea, fever, delirium, and coma.[bestpractice.bmj.com]
  • […] of inflammatory pathways via cytokines Suppression of physiologic anticoagulant pathways Activation and/or impairment of fibrinolysis Clinical Presentation Generally occurs in the setting of a risk factor listed above Hemorrhage – petechiae, purpura, epistaxis[arupconsult.com]
  • Physical examination The most common symptoms are blood loss from wounds, gums and gastrointestinal track, bleeding into the skin, hematuria, and/or epistaxis .[medical-dictionary.thefreedictionary.com]
  • In the chronic DIC associated with underlying malignancy, patients may develop epistaxis, purpura, or inter-current thrombocytopenia. In patients without a prior diagnosis of a malignancy, these events may eventuate in the discovery of cancer.[cancertherapyadvisor.com]
  • It can cause petechial and ecchymotic lesions in the subcutaneous tissues along with epistaxis and gum bleeding.[clinicaladvisor.com]
Hematuria
  • Two weeks later, he was transferred to the West China Hospital with nasal hemorrhage for 1 week, hematochezia, hematuria, and petechiae for 5 days. Laboratory data and symptoms on admission indicated DIC.[ncbi.nlm.nih.gov]
  • References: [3] [4] Clinical features Bleeding manifestations Petechiae , purpura , ecchymoses Oozing of blood from surgical wounds, intravenous lines Hematuria Hematemesis , hematochezia Collection of blood in body cavities: features of hemoperitoneum[amboss.com]
  • […] malignancy, liver disease, retained dead fetus syndrome, abdominal aortic aneurysm, giant hemangioma and head trauma Bleeding can present as surgical site, venipuncture site or mucocutaneous bleeding (most common) Gastrointestinal bleeding, CNS bleeding, hematuria[pathologyoutlines.com]
  • Physical examination The most common symptoms are blood loss from wounds, gums and gastrointestinal track, bleeding into the skin, hematuria, and/or epistaxis .[medical-dictionary.thefreedictionary.com]
  • Intraoperative DIC (due to trauma, ABO incompatibility reactions, or concurrent sepsis) may be evident only by hematuria or excessive bleeding at the surgical site.[clinicaladvisor.com]
Oliguria
  • Clinical history can include epistaxis, gingival bleeding, haematuria, oliguria, cough, dyspnoea, fever, delirium, and coma.[bestpractice.bmj.com]
  • Petechiae , purpura , ecchymoses Oozing of blood from surgical wounds, intravenous lines Hematuria Hematemesis , hematochezia Collection of blood in body cavities: features of hemoperitoneum , hemothorax Thrombotic manifestations Acute renal failure : oliguria[amboss.com]
  • […] mucocutaneous bleeding (most common) Gastrointestinal bleeding, CNS bleeding, hematuria or ecchymoses Thrombosis can present as purpura fulminans (manifestation of subdermal microthrombi with skin necrosis) Cold, pulseless limb Sudden loss of vision Oliguria[pathologyoutlines.com]
  • Note the presence of oliguria and compare current urine output with previous readings. Psychosocial Patients may feel a sense of “impending doom,” and the family is probably fearful of losing a loved one.[medical-dictionary.thefreedictionary.com]
Vaginal Bleeding
  • Symptoms of Disseminated Intravascular Coagulation Abnormal bleeding from anywhere in the body, possibly at several sites at once Tiny, red, pinpointlike dots (petechiae) Vomiting of blood Bloody or black stools Blood in the urine Vaginal bleeding Unexplained[healthcommunities.com]
  • Other symptoms are: blood clots decreased blood pressure easy bruising rectal or vaginal bleeding red dots on the surface of the skin ( petechiae ) If you have cancer, DIC generally begins slowly, and clotting in the veins is more common than excessive[healthline.com]
  • Assess the patient’s skin for any petechiae, ecchymoses, hematoma formation, epistaxis, bleeding from wounds, vaginal bleeding in the labor or postpartum patient, hematuria, conjunctival hemorrhage, and hemoptysis.[medical-dictionary.thefreedictionary.com]
Dark Urine
  • […] pink or dark urine. On dipstick , the urine will be positive for “blood,” but there will be no red blood cells on microscopy .[medicalmediareview.com]
Confusion
  • Heat stroke is a life-threatening condition which is characterised by nausea, vomiting, confusion, disorientation and coma. Aggressive treatment in the form of intravenous fluids along with other symptomatic management can be life saving.[ncbi.nlm.nih.gov]
  • However, some confusion still exists in the definition and management of DIC since various specialists understands the mechanisms involved in DIC from different perspectives.[ncbi.nlm.nih.gov]
  • […] injury (as in burns and head injury) Large hemangioma (a blood vessel that is not formed properly) Symptoms of DIC may include any of the following: Bleeding, from many sites in the body Blood clots Bruising Drop in blood pressure Shortness of breath Confusion[medlineplus.gov]
  • […] acute situation there are many presenting features that may be found: Bleeding from at least three unrelated sites is typical and likely sites include: Ears, nose and throat Gastrointestinal tract Respiratory tract Site of venepuncture or IV infusion Confusion[patient.info]
  • Confusion results by virtue of the severe liver disease, which itself (without excessive thrombin production) results in prolongations of the prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), accumulation of fibrin degradation[cancertherapyadvisor.com]
Seizure
  • Treatment of seizures Treatment of seizures depends on the underlying disorder causing the DIC.[epilepsy.com]
  • Although one episode of seizures was noted, electroencephalogram was normal. With the application of obstetric vacuum, we recommend that the neonatal health care professionals frequently evaluate the infant's condition.[ncbi.nlm.nih.gov]
  • […] or loss of consciousness in advanced cases (rare) Nausea Difficulty breathing (dyspnea) Seizures Organ failure Prevention of Disseminated Intravascular Coagulation Disorders that could result in DIC require prompt treatment.[healthcommunities.com]
  • […] common) Gastrointestinal bleeding, CNS bleeding, hematuria or ecchymoses Thrombosis can present as purpura fulminans (manifestation of subdermal microthrombi with skin necrosis) Cold, pulseless limb Sudden loss of vision Oliguria Mental status changes, seizures[pathologyoutlines.com]
  • Typical thrombotic features of DIC are thrombophlebitis developing at unusual sites; respiratory distress syndrome; development of renal impairment without obvious explanations; central nervous system disturbances such as confusion and seizures, typically[anesthesiology.pubs.asahq.org]
Altered Mental Status
  • mental status , stroke Purpura fulminans: DIC with extensive skin necrosis Waterhouse Friderichsen syndrome : adrenal infarcts adrenal insufficiency The clinical features of DIC may appear acutely (e.g., following trauma, sepsis ), or may appear subacutely[amboss.com]
  • Following a prolonged extrication, the patient was intubated in the field secondary to altered mental status (GCS 6).[emdocs.net]

Workup

The first observation, in order to diagnose DIC is to ask for the patient’s medical history. History of stroke, uncontrolled bleeding, et cetera may collaborate a diagnosis of DIC. Apart from this, other tests may be done to confirm a diagnosis of DIC.

  • Complete blood count and blood smear: This gives the RBC count, WBC count, hemoglobin count, hematocrit, platelet count, etc.
  • Fibrin degradation: Fibrin degradation products are those that are left behind after the blood clot dissolves. This test measures the amount of this substance in the blood.
  • Fibrinogen/CRP ratio: This ratio gives a predictive outcome of DIC can guide the surgeon about his treatment options [7].
  • Partial thromboplastin time: This test measures the time taken for blood to clot.
  • Serum fibrinogen: This test measures the amount of fibrinogen present in the blood
Decreased Platelet Count
  • Blood tests revealed a decreased platelet count, disseminated intravascular coagulation (DIC), renal dysfunction, hemolysis, and infection.[ncbi.nlm.nih.gov]
  • Diagnosis is based on presence of 1 known underlying conditions causing DIC plus abnormal global coagulation tests: decreased platelet count, increased prothrombin time, elevated fibrin-related maker (D-dimer/fibrin degradation products), and decreased[bestpractice.bmj.com]
  • A patient with a DIC triggering disease process, with a decreasing platelet count and abnormal coagulation profile should suggest onset of DIC. Further tests may help hone in on the diagnosis while ruling out the most common mimickers of DIC.[clinicaladvisor.com]
Fibrinogen Decreased
  • Decreased in DIC May not be accurate in early disease because it is an acute phase reactant Clotting times and coagulation factors may be inaccurate in the presence of interfering substances, including drugs administered for anticoagulation Refer to[arupconsult.com]
  • In acute DIC, PT and aPTT are prolonged, and the platelet count and fibrinogen decrease. D-dimer, FDP, and fibrin monomer levels are elevated. In subacute or chronic DIC, PT and aPTT may be prolonged or normal.[patient.info]
Prothrombin Time Increased
  • time (increase in seconds) 3-6 6 FEU fibrinogen equivalent units Toh, ISTH, 2007 Laboratory Testing D-dimer – increased in acute and chronic DIC (best single test) Normal D-dimer essentially rules out DIC (excellent negative predictive value) Low specificity[arupconsult.com]

Treatment

The treatment for DIC depends on the severity of the condition and also on the underlying disease. Effective treatment for the underlying condition is the most effective way of treating DIC.
In case of acute DIC blood transfusion may allay the situation. Acute bleeding with chronic leukemia may be stabilized with the infusion of plasma extenders and tranexamic acid [8].

This is done to compensate the excessive loss of blood. Platelets (platelet concentrate) and clotting factors may be given to the patient via rapid blood transfusion [9]. Patients complicated with sepsis may benefit from the administration of activated C-protein which is the only approved therapeutic approach recognized in the US for these cases [10]. In case of chronic DIC blood thinners such as heparin may be given in order to prevent clot formation.

Prognosis

The prognosis of a patient with disseminated intravascular coagulation depends on the severity of the inciting condition and the very coagulation in itself. DIC can be handled effectively with the proper treatment of the primary underlying condition.

Consequently with DIC, fibrin depositions in vessels of some organs can result in ischemia. The deposition of fibrin can also lead multiple organ failure and can evidently lead to death. DIC can increase the chances of mortality in patients with sepsis and severe trauma.

Complications

The following are a few of the complications associated with DIC:

  • Bleeding: The excessive, uncontrollable bleeding is life threatening and can result in death. The underperfused liver due to DIC may result in the impaired production of Antithrombin which aggravates the bleeding problems [6].
  • Lack of oxygen: The presence of clots in the blood vessels reduces the blood supply hence the lack of oxygen supply to the organs which can lead to organ damage.
  • Stroke: Formation of blood clots in the vessels of the brain can lead to stroke.

Etiology

As mentioned earlier, DIC in itself is not a disease but a manifestation in itself of other illnesses. Some of these illnesses have been shown to cause DIC:

Epidemiology

Disseminated intravascular coagulation is a rare condition that occurs in only 1% of all hospitalized patients [3]. The risk for DIC may be higher for those with ongoing sepsis which can reach up to 30-50% of cases [4].

The mortality rate for DIC is 50-75%. No evidence has been raised that DIC is influenced by genetics, geography, race, gender, age or socioeconomic status.

Sex distribution
Age distribution

Pathophysiology

Disseminated intravascular coagulation is caused when the control mechanism of hemostasis is disrupted. This leads to widespread intravascular coagulation. When the hemostatic system is system is disturbed, inflammatory cytokines are released.

This leads to uncontrolled thrombin generation. The disturbance in the hemostatic system can be due to thrombin generation which is mediated by tissue factors or imbalance in thrombin generation which may be triggered by inflammation. The uncontrolled thrombin generation leads to microvascular thrombosis and impaired anticoagulant pathways. In patients with DIC the levels of antithrombin (an inhibitor of thrombin) in the plasma is considerably less; thus, thrombin overproduction remains unopposed. The reduced level of antithrombin correlates with an increased rate of mortality, especially in patients with sepsis or septic shock.

Tissue damage leads to fibrin deposition. This releases and activates plasminogen which in turn initiates plasmin generation. The generation of a plasmin inhibitor α2 antiplasmin is also reduced into a much lower level than that of plasmin.
Plasmin degrades clotting factors VIII, V and I where fibrinogen degradation products are also produced. All of these products, along with fibrin which isn’t polymerized completely, lead to impaired platelet function and abnormal fibrin polymerization causing uncontrolled bleeding.

Microvascular thrombosis causes ischemia, necrosis, release of tissue factors, and organ dysfunction. Intravascular coagulation is consequently accelerated due to this phenomenon.
In acute DIC consumption of platelets and clotting factors occur faster than they can be replaced which leads to uncontrolled bleeding. Trauma patients presents with an acute phase fibrinolysis causing a consumptive type of coagulation disorder leading to uncontrolled bleeding [5].

Whereas in chronic DIC the time and intensity of trigger varies rendering the regulatory mechanism of coagulation with more control comparatively.

Prevention

The best way to prevent DIC is the timely treatment of the conditions that can lead to DIC. This condition can be managed with proper medication. Since DIC is not an illness in itself, the only prevention method available is to treat the condition that can lead to DIC.

Summary

Disseminated intravenous coagulation (DIC) is a condition in which the excessive release of thrombin and other clotting factors cause clotting in the small vessels of the body. This leads to the excessive generation and systemic deposition of fibrin. This in turn leads to Multiple Organ Dysfunction Syndrome (MODS) or multi-organ failure that eventually causes death [1].

Disseminated intravascular coagulation is not a disease in itself but it is a complication which presents itself as an illness progresses.

There are two types of DICs, the acute and the chronic type. Acute DIC progresses in a very short duration of time and immediate treatment is required. The progression of chronic DIC is slower compared to the acute form. Chronic DIC presents symptoms later than acute DIC and is usually caused by cancer. Solid tumors and large aortic aneurysm may also lead to chronic DIC [2].

Patient Information

In case of unstoppable bleeding, go to the doctor immediately
When signs of internal or external bleeding are observed, seek medical attention immediately.

References

Article

  1. Vincent JL, De Backer D. Does disseminated intravascular coagulation lead to multiple organ failure?. Crit Care Clin. Jul 2005;21(3):469-77.
  2. Levi M. Disseminated intravascular coagulation: What's new?. Crit Care Clin. Jul 2005;21(3):449-67.
  3. Matsuda T. Clinical aspects of DIC--disseminated intravascular coagulation. Pol J Pharmacol. Jan-Feb 1996;48(1):73-5.
  4. Fourrier F, Chopin C, Goudemand J, Hendrycx S, Caron C, Rime A, et al. Septic shock, multiple organ failure, and disseminated intravascular coagulation. Compared patterns of antithrombin III, protein C, and protein S deficiencies. Chest. Mar 1992;101(3):816-23.
  5. Hayakawa M, Sawamura A, Gando S, Kubota N, Uegaki S, Shimojima H, Sugano M, Ieko M. Disseminated intravascular coagulation at an early phase of trauma is associated with consumption coagulopathy and excessive fibrinolysis both by plasmin and neutrophil elastase. Surgery. 2011; 149(2):221-30 (ISSN: 1532-7361)
  6. Carey MJ, Rodgers GM. Disseminated intravascular coagulation: clinical and laboratory aspects. Am J Hematol. Sep 1998;59(1):65-73
  7. Windsperger K, Lehner R. The fibrinogen/CRP ratio as a new parameter for the diagnosis of disseminated intravascular coagulation in patients with HELLP syndrome and as a predictive factor for neonatal outcome. Am J Obstet Gynecol. 2013; 208(2):118.e1-7 (ISSN: 1097-6868).
  8. Martí-Carvajal AJ, Simancas D, Cardona AF. Treatment for disseminated intravascular coagulation in patients with acute and chronic leukemia. Cochrane Database Syst Rev. 2011; (6):CD008562 (ISSN: 1469-493X)
  9. Gando S, Sawamura A, Hayakawa M. Trauma, shock, and disseminated intravascular coagulation: lessons from the classical literature. Ann Surg. 2011; 254(1):10-9 (ISSN: 1528-1140)
  10. Hook KM, Abrams CS. The loss of homeostasis in hemostasis: new approaches in treating and understanding acute disseminated intravascular coagulation in critically ill patients. Clin Transl Sci. 2012; 5(1):85-92 (ISSN: 1752-8062).

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Last updated: 2018-06-21 17:21