DIC

DIC
• DIC stands for Disseminated intravascular
coagulation.
• It is the disturbance of the bloodclooting
mechanism
• Several clots in some vessels increase
consumption of the blood clotting factors
and platelets deficiency, lack or
destruction of those factors in other body
parts Several bleedings in other areas
of the body.
 Patogenesis
1) Generation of a hyperthrombinemic state
2) Alteration of the physiological anticoagulants
levels
3) Impaired fibrinolysis at the onset of the DIC:
4) Activation and liberation of inflammatory
cytokines in the pathogenesis of DIC
1) Generation of a hyperthrombinemic
state
• The exposing of the tissue factors thromboplastin
and factor III during injury causes a cascade
activation of a factor pathway that has a
dominant role in the hyperthrombinemic state in
DIC.
• Cytokines and bacterial endotoxin are all triggers
to the formation of endothelial cell tissue factor.
• In severe trauma also tissue phospholipids
initiates the clotting cascade.
cont.: The cascade goes here as
follows
cont.: The Thrombin in turn activates
 2) Alteration of the physiological
anticoagulants levels
• There are 3 most common Anticoagulants in
the body:
-Antithrombin,
- Active Protein C
-Tissue factor pathway inhibitor (TFPI).
• In DIC:
-↓Antithrombin
-↓Active Protein C
 cont.: The cause of the
The cause of the decrease
cont.:
decrease

 Protein C function

Normally in DIC
3) Impaired fibrinolysis at the onset of
the DIC:
• Plasminogen activator inhibitor 1 (PAI-1) is a
neurohumoral compound released by the
endothelial cells at the effected site.
• PAI-1 suppresses the normal fibrinolysis
activity.
• Some DIC individuals have shown a mutation
in the PAI-1 gene, leading to an increased
plasma PAI-1 levels.
 Signs & symptoms of DIC
• Renal failure
• Cough
• Confusion
• Decreased platelets
• Blood clots
• Drop in blood pressure
• Sudden bruising
• Bleeding, possibly from multiple sites in the body
• Fever
Sites of Thrombosis

Site in decreasing
order of frequency
Brain
Heart
Kidney
Adrenals
Spleen
Lungs
Liver
 DIC associated syndrome
DIC Is most likely to occur after sepsis, obstetric
Is most likely to occur after sepsis, obstetric
complications, malignancy, and major trauma
complications, malignancy, and major trauma
(especially trauma to the brain)
 Obstetric complications
• Abruption placentae
• Retained dead fetus
• Septic abortion
• Amniotic fluid embolism
• Toxemia
 Infections
• Sepsis (gram negative and gram positive)
• Meningococcemia
• Rocky Mountain spotted fever
• Histoplasmosis
• Aspergillosis
• Malaria
 Neoplasms
• Carcinomas of pancreas, prostate, lung, and
stomach
• Acute promyelocytic leukemia

Massive Tissue Injury

• Trauma
• Burns
• Extensive surgery
 Miscellaneous
• Acute intravascular hemolysis,
• Snakebite,
• Giant hemangioma
• Shock
• Heat stroke
• Vasculitis
• Aortic aneurysm,
• Liver disease
• Rejection of graft
 Laboratorium investigations of DIC
• CBC
thrombocytopenia is usually present
• Clotting times:
- Prothrombin time (PT) – prolonged (may be normal in early or chronic DIC)
- Partial thromboplastin time (PTT) – prolonged (may be normal in early or
chronic DIC)
- Thrombin time (TT) – may be increased due to consumption of fibrinogen
• Fibrin related markers important for the diagnosis of DIC:
- D-dimer – increased in acute and chronic DIC (best single test) A normal
d-dimer essentially rules out DIC
- Elevated d-dimer levels are seen in a number of conditions in addition to
DIC (eg, pregnancy, acute thrombosis)
• Coagulation factors:
- Fibrinogen is usually decreased (in an acute phase of DIC, the fibrinogen
may not be decreased, only until DIC is severe)
International Society on Thrombosis and
Haemostasis Scoring System for Diagnosis of
DIC

A score below 5 is suggestive as a diagnosis but

not definite; hence the test must be repeated.
 Treatment
• The most important fact in the management of DIC, is
the treatment of the underlying cause.
• Supportive therapy may be given to patients with
excessive bleeding:
1) Fluid
2) Blood transfusion
3) Fresh frozen plasma
4) Platelet concentrates
5) Fibrinogen
• Patients with chronic DIC and thrombosis may need
heparin therapy.