Disseminated Intravascular Coagul

Rahmawati Minhajat
Tutik Harjianti
Div. of Hematology & Medical Oncology
Dept. of Internal Medicine, Medical Faculty
Hasanuddin University
Sub Topics
Introduction of DIC.

Trigger Mechanism of DIC.

Etiology of DIC.

Clinical pictures of DIC.

Diagnosis of DIC.

Management of DIC.

Prognosis of DIC.

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 I. Introduction

D.I.C :
Disseminated : widespread
Intravascular : inside the bloodline
Coagulation : blood clot production

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Physiology of Blood Circulation

Blood always in a liquid form

Vascular disruption initiate coagulation

(as a part of normal homeostasis )

Coagulation is limited in area of lesion by the

effect of :
- blood streaming / blood flow
- coagulation inhibitor inside the circulation
(esp. Anti Thrombin III / AT III)

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Physiology of Coagulation
Vasculature rupture/ lesion

Vasoconstriction

Primary homeostasis reaction

homeostasis
mechanism
Coagulation

Fibrinolysis

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Why DIC can be occured?

Overstimulation of coagulation

suppression of control mechanism

DIC

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Important Clue

The presence of thrombin circulating in

bloodline.

Normally : thrombin can only be found in

area of lesion (where the
coagulation process is still
running)

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

Result of excess of thrombin

1 Decreased of fibrinogen

1
2 Decreased of platelet

3 Decreased of coagulation factors

4 Exaggerated of fibrinolysis

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 II. Trigger Mechanism of DIC

1 TUMOR RELEASE OF
Tissue TRAUMA
Tissue NECROSIS
TISSUE FACTOR
INTO CIRCULATION
DIC
2 ENDOTOXIN ACTIVATION of COAG.
GRAM NEGATIVE BACT. CASCADE (F.XII)
DIC

EXPRESSION of TISSUE
FACTOR in MONOCYTE ACCELERATION of COAG RX
& ENDOTHELIAL cells

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 III. Etiology of DIC

DIC is not a stand alone disease entity, as

a result of severe disease or condition:

Sepsis: gram +, gram -, & fungal infection

Tissue necrosis: trauma & combustio/ burn
Obstetric: abortus, emboli of liquor amnion,
fetal death
Malignancy: leukemia, Ca

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Other cause of DIC

Major hemolytic reaction as a result of

blood transfusion error!.

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 IV. Clinical Pictures of DIC

1. Abnormal coagulation
2. Bleeding (more often)
- can be found at any place
- spontaneous bleeding
- at the site of wound, cath etc.

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Coagulation disorders in DIC

Thrombosis can be occurred if the

abnormality of coagulation more prominent
than fibrinolysis
- digital ischemia
- gangrene (necrosis)
- Necrosis of cortex of kidney
- Adrenal gland necrosis & bleeding

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Trousseau Syndrome

Sub-acute DIC
Often found in cancer patients
Thrombosis in superficial & profundal veins
(DVT), commonly recurrent

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 V. Diagnosis of DIC

1. Clinical pictures (severe disease, bleeding,

thrombosis)
2. Laboratory :
- Fibrinogen <
- FDP >
- Platelet <
- Prothrombin Time >
- activated Partial Thromboplastin Time
(aPTT) >

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Differential Diagnosis of DIC

Liver Diseases (normal fibrinogen )

Vit K defc (normal fibrinogen & platelet)

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 VI. Management of DIC
Treat the underlying disease/condition.
Replacement Tx:

Platelet concentrate transfusion

(maintain the platelet > 50.000 / mm3)

Dose: 1 unit/ 10kgBW.

5 7 units PC may increase 5000

10.000/uL PLT in adult with BW 70kg.

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

Management

Cryoprecipitate transfusion
(maintain the fibrinogen > 150.000 mg/dL)

dose: 10 units for adult with BW 70 kg.

may increase fibrinogen 60 - 100 mg/dl

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

Management

Fresh Frozen Plasma transfusion

(to increase coagulation factors)

Dose: 10 15ml/ kgBW or

3 4 units for adult with BW 70kg.

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 Management
Heparin : still controversial
Should be given with Replacement Tx
Dose : 500 750 u/ hour

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

 VII. Prognosis of DIC

Depends on :
1. Severity of coagulation reaction
2. Amount of bleeding
3. Etiology of DIC (malignancy etc)

Division of Hematology & Medical Oncology - Dept. of Internal Medicine

Thank You !