Please enable JavaScript.
Coggle requires JavaScript to display documents.
Disseminated Intravascular Coagulation (DIC) - Coggle Diagram
Disseminated Intravascular Coagulation (DIC)
Causes
Sepsis
Major trauma and tissue destruction
Initiating factors are:
Extensive damage to vascular endothelium thereby exposing tissue factor
Enhance expression of tissue factor by monocytes in response to cytokines
Advanced cancer
Massive activation of the coagulation cascade
Obstetric complications
Pathophysiology
Widespread systemic generation of fibrin within blood vessels caused by the initiation of the coagulation pathway
Either cause microvascular thrombosis and thus organ failure OR:
Cytokine release in response to SIRS (systemic inflammatory response syndrome) - usually causes by sepsis, trauma, pancreatitis, obstetric emergency or malignancy
The consumption of platelets and coagulation factors, leading to bleeding by inhibiting fibrin polymerisation (thus fibrin cannot polymerase)
Clinical Presentation
Confusion
Bruising
Bleeding may occur from the mouth, nose and venipuncture sites and there may be widespread ecchymoses (discolouration of skin due to bleeding caused by bruising)
Thrombotic events occur as a result of vessel occlusion by fibrin and platelets - any organ may be involved but the skin, brain and kidneys are most affected
Patient is often acutely ill and shocked
Diagnosis
Decreased fibrinogen
Elevated FDPs (fibrin degradation products) e.g. D-dimer due to the intense fibrinolytic activity that is stimulated by the presence of fibrin in the circulation
Diagnosis can be suggested from history e.g. severe sepsis, trauma or malignancy, clinical presentation and thrombocytopenia
Blood film shows fragmented RBCs
Severe thrombocytopenia
Prolonged Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT) and Thrombin Time (TT)
Treatment
Fresh Frozen Plasma (FFP) to replace the coagulation factors
Cryoprecipitate to replace fibrinogen and some coagulation factors
Replace platelets if they are very low via transfusion
Red cell transfusion in patients who are bleeding
Treat underlying condition