Disseminated intravascular coagulation (DIC), also known as consumption coagulopathy, is the generation of fibrin in the circulating blood. Fibrin is the insoluble protein that forms the matrix of a clot. In other words, this is what holds the platelets, red blood cells etc. together to form a clot. When there is bleeding, this is a good thing, but in DIC, the fibrin forms freely throughout the blood stream.
DIC can be triggered by (generally) three causes:
Other, less common, causes of DIC include head trauma disrupting the blood-brain barrier, prostatic surgery complications, or venomous snake bites.
The most recent case I saw was due to long-term (30 year) use of steroids, Demerol and Phenergan for severe asthma and back pain. This patient was an inpatient in the hospital (she spent about 9 months out of the year hospitalized) when she developed a severe nosebleed which did not respond to pressure, ice, or electrocoagulation. The ENT doctor was consulted and placed a balloon device in the nose to apply internal pressure. That seemed to control the bleeding. The next day, the patient developed symptoms of a massive stroke. When she was rushed to the ICU, the EEG showed no brain activity. She was kept on life support until her brother could return from Korea, then disconnected.
DIC is characterized by disseminated clotting throughout the body creating scores of microemboli floating around, looking for a place to infarct (stroke, heart attack, pulmonary embolism or other ischemic tissue damage), and paradoxical unstoppable bleeding, due to the fact that all the clotting factors are being used up elsewhere.
Signs and symptoms of DIC include decreased level of consciousness, fainting, agitation, numbness or tingling, pain in an extremity, diminished or absent peripheral pulses, pale, clammy extremities, EKG changes, angina, hypotension, cyanosis, tachycardia, heart murmurs, dysrhythmias, tachypnea, dyspnea, oliguria, blood or protein in the urine, diminished or absent bowel sounds, abdominal pain, mottling of the skin, bruising, hematomas, petechiae, purpura, oozing of blood from puncture sites, incisions, and mucous membranes, vomiting of blood, nosebleeds, or coughing up blood.
Diagnosis of DIC is made through patient history and examination, as well as lab tests showing thrombocytopenia, markedly prolonged PT/PTT, a severely reduced plasma fibrinogen (fibrin precursor) concentration, and a high D-dimer and fibrin degradation productlevel.
Treatment of DIC is mainly based on correcting the underlying cause of the coagulopathy. If there is serious bleeding, blood replacement with packed red blood cells, fresh frozen plasma, platelets and cryoprecipitate is indicated. If thromboembolic complications begin to be suspected, heparin is administered to prevent further clotting. Rest and oxygen therapy are important supportive therapies.
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