Disseminated Intravascular Coagulation (DIC)
Before we proceed, let us first define what is DIC. Disseminated Intravascular Coagulation (abbreviated as DIC), is an acquired hematological disorder characterized by the abnormal clotting of blood where fibrin formation causes micro vascular thrombi in selected organs. This disorder is known to influence the development of multiple organ dysfunction syndrome (MODS).
1. Causes/Risk factors.
The apparent derangement of the fibrinolytic system contributes to intravascular clot formation. Normally, disseminated intravascular coagulation is never an illness but rather a complication or a result of a prolonged illness.
In other words, it is a secondary manifestation of an underlying condition(s). It is associated with various clinical disorders such as: severe hepatic failure, solid cancer, sepsis, and trauma (neurotrauma) among others.
2. Categorized into two types.
Disseminated Intravascular Coagulation presents itself in two main types, namely: acute DIC and chronic DIC.
Acute DIC displays when the sudden exposure of blood to procoagulants (e.g. Tissue factors (TF), thromboplastin etc.) causes intravascular coagulation. More precisely, the condition happens when the body’s compensatory hemostatic mechanism becomes drastically overwhelmed, leading to hemorrhage.
Chronic DIC depicts a compensated state that occurs when blood is continuously exposed to small amount of Tissue factors (TF). In comparison to acute DIC, the compensatory mechanisms (in the liver and bone marrow) are not overwhelmed. Chronic DIC is more common among patients with compact tumors as well as those with large aortic aneurysms.
3. Signs and symptoms of Disseminated Intravascular Coagulation.
The signs and symptoms of Disseminated Intravascular Coagulation relies mainly on its cause and whether the condition is chronic or acute.
Acute DIC is known to advance quickly and possesses severe risk to patients. Chronic DIC progresses more slowly (it may take weeks or months). The condition lasts longer and it does not readily present clinical conditions unlike the Acute DIC.
In acute DIC, blood clots form within the blood vessels after which bleeding follows. However, this may not always be the case in all patients. The first sign can be presented with serious instances of bleeding in some cases (sometimes marked with internal bleeding).
In chronic DIC, blood clots form within blood vessels but no bleeding occurs. Sometimes chronic DIC absolutely presents no signs or symptoms.
Generally, in DIC, clots form throughout the capillaries hence blocking or reducing blood flow in the body. This may sometimes lead to a number of complications in patients, e.g. chest pains and shallow breath when blood clots form in the blood vessels of the patient’s heart or lung.
Redness of the skin, a drop in blood pressure, and swelling of the lower leg can be symptoms of DIC. Other possible symptoms include paralysis, headaches, and sometimes trouble with speech.
4. Diagnostic tests.
The diagnosis for DIC is often dependent on a number of factors. These factors may include one or all of the following: a patient’s medical history, a physical exam, and/or doctor’s test results.
Medical history looks into any record of previous illnesses or conditions that may trigger DIC while physical exams may simply refer to certain observations by the physician. It will be an assessment to identify the presence of any symptoms of blood clotting and bleeding. The doctor’s test results refer to specific results conducted on the patient’s blood in the examination of blood cells and other relevant data.
There are two major categories of tests that is normally performed to help establish a diagnosis. These tests include: Complete Blood Count & Blood Smear Tests; and Clotting Factors & Clotting Time Tests.
Complete Blood Count and Blood Smear Tests determine the number of red blood cells, platelets, and white blood cells while the Clotting Factors and Clotting Time Tests measure the amount of protein in the blood and the overall time it takes to clot.
The most commonly conducted examinations with Clotting Factors and Clotting Time Tests include: PT and PTT, Serum fibrinogen, and fibrin degradation tests.
PT and PTT tests measure the length of time required for the blood to clot while Serum fibrinogen (blood protein that helps the blood to clot) determines how much fibrinogen is present in the blood. The last test (fibrin degradation), measures the amount of degraded fibrins. The fibrins are degradation substances formed after a blood clot dissolves.
DIC has no known prevalence in gender. Both male and female stand an equal chance of developing the condition.
It is also known to affect people of all ages regardless of the geographical location. Regarding connection with genetic factors, it also has no known genetic influence.
6. DIC Treatment.
The treatment of Disseminated Intravascular Coagulation mostly depends on the cause and the severity of the condition. The main goal in the treatment of the condition is usually directed towards the control of bleeding complication and reduction in clotting.
For underlying causes, immediate correction is recommended e.g. administration of a broad spectrum anti-biotic treatment for suspected gram-negative sepsis.
Patients with acute DIC require emergency treatment. Such treatment may incorporate administration of medicine, blood transfusion, and even oxygen therapy. Blood transfusion is a common practice. It is usually needed to replace the blood lost from injury or bruise.
For patients with chronic DIC, treatment is provided with the administration of anticoagulants or blood thinners to prevent blood coagulation.
7. Preventing/ Avoiding Disseminated Intravascular Coagulation.
Preventive measures for the condition can be categorized into two broad categories namely: primary prevention methods and secondary prevention methods.
The objective of primary prevention focuses on either the early treatment of the condition or the treatment of underlying conditions responsible for precipitating the condition.
Secondary prevention involves active and effective treatment of the condition to repair the deranged coagulation system.
8. Incidence and prevalence.
According to researches, DIC accounts for one percent of all hospitalized patients.
Scholars also attribute around 30 percent to 50 percent of DIC patients to display severe sepsis with mortality rate at around 50 percent to 75 percent.
Normally, the mortality rate depends on the underlying disorder but the condition worsens the prognosis of the disorders.
- Balwinder Singh, Ognjen Gajic, & Guangxi Li (2012). Incidence And Outcome Of Disseminated Intravascular Coagulation (DIC) In Olmsted County, Minnesota (2004-2010)-A Population Based Cohort Study.
- Chrysoula Papageorgiou, MD, Georges Jourdi, MD, PhD, Eusebe Adjambri, MD, Amanda Walborn, PhD, Priya Patel, PhD, Jawed Fareed, PhD, Ismail Elalamy, MD, PhD, Debra Hoppensteadt, PhD, & Grigoris T. Gerotziafas, MD, PhD (2018). Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies.
DIC is commonly associated with organ failure. The display of infarction and limb ischemia due to DIC can be significantly fatal to the organs.
Consistent internal bleeding in different body parts can also be a dangerous complication of the condition. There are also known cases of paralysis caused by DIC.
10. Miscellaneous factors.
There are some rare instances that can lead to the development of DIC. These unusual situations include the onset of heat stroke, a hit by a lightning strike, and snake bite.
Some recreational drugs such as cocaine can also lead to the medical condition. This is possible due to the damage it creates in the epithelium and the release of tissue factor that the drug exhibits.
DIC Medical School
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