What is disseminated intravascular coagulation

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Understanding Disseminated Intravascular Coagulation (DIC)

Definition and Pathophysiology of DIC

Disseminated Intravascular Coagulation (DIC) is an acquired syndrome characterized by widespread activation of the blood coagulation system, leading to the generation and deposition of fibrin within the blood vessels. This process results in the formation of microvascular thrombi in various organs, contributing to multiorgan failure and severe bleeding complications due to the consumption and subsequent depletion of coagulation proteins and platelets .

Causes and Triggers of DIC

DIC is always secondary to an underlying condition. Common triggers include severe infections (such as sepsis), trauma, malignancies (both solid and hematologic), and obstetric complications . The syndrome can be initiated by both infectious and non-infectious insults, leading to a systemic inflammatory response that activates the coagulation cascade .

Clinical Manifestations and Complications

Patients with DIC can present with a combination of thrombotic and bleeding problems. The systemic activation of coagulation can lead to thrombotic obstruction of small and midsize vessels, causing organ dysfunction. Simultaneously, the ongoing consumption of platelets and coagulation proteins can result in thrombocytopenia and severe hemorrhagic complications . In obstetric cases, DIC is a significant contributor to maternal morbidity and mortality, often associated with conditions like placental abruption and amniotic fluid embolism.

Diagnostic Criteria and Scoring Systems

The diagnosis of DIC relies on clinical assessment and laboratory tests. The International Society on Thrombosis and Haemostasis (ISTH) has established a diagnostic scoring system based on global hemostatic test parameters, which has been validated in various clinical settings . Repeated laboratory tests for coagulation profiles and clotting factors are essential to support the diagnosis.

Management and Treatment Strategies

The cornerstone of DIC management is the treatment of the underlying condition. Supportive treatments may include the administration of heparin, platelet concentrates, plasma, or coagulation factor concentrates, especially in patients with significant bleeding or at risk for hemorrhagic complications . Recent studies have explored the efficacy of antithrombin, activated protein C, and tissue factor pathway inhibitors in sepsis-related DIC, with mixed results.

Conclusion

Disseminated Intravascular Coagulation is a complex syndrome resulting from systemic activation of the coagulation system, leading to both thrombotic and bleeding complications. Early diagnosis and prompt treatment of the underlying cause, supported by appropriate laboratory tests and scoring systems, are crucial for improving patient outcomes. Understanding the pathophysiology and clinical manifestations of DIC is essential for effective management and reducing associated morbidity and mortality.