The following organ systems heralds the following manifestation during a disseminated intravascular coagulation:
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.
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 .
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 . 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 . In case of chronic DIC blood thinners such as heparin may be given in order to prevent clot formation.
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.
The following are a few of the complications associated with DIC:
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:
Disseminated intravascular coagulation is a rare condition that occurs in only 1% of all hospitalized patients . The risk for DIC may be higher for those with ongoing sepsis which can reach up to 30-50% of cases .
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.
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 .
Whereas in chronic DIC the time and intensity of trigger varies rendering the regulatory mechanism of coagulation with more control comparatively.
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.
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 .
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 .