Medicine & USMLE

Disseminated Intravascular Coagulation (DIC)

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Platelet Disorders
  1. Platelet Plug Formation
  2. Von Willebrand Disease
  3. Bernard-Soulier Syndrome
  4. Glanzmann Thrombasthenia
  5. Immune Thrombocytopenic Purpura (ITP)
  6. Thrombotic Thrombocytopenic Purpura (TTP)
  7. Hemolytic Uremic Syndrome (HUS)
  8. Disseminated Intravascular Coagulation (DIC)

Summary

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Key Points

  • Disseminated Intravascular Coagulation (DIC)
    • Pathogenesis
      • Release of procoagulants → widespread abnormal clotting → consumption of platelets and clotting factors → susceptibility to bleeding
      • Microthrombi formation can also cause mechanical shearing of RBCs → microangiopathic hemolysis
      • Causes
        • Snake bites
        • Sepsis (gram negative)
        • Trauma
        • Obstetric complications
        • Acute pancreatitis
        • Malignancy (e.g. AML)
        • Nephrotic Syndrome
        • Transfusion
    • Presentation
      • Bleeding from all orifices
        • E.g. catheter sites and mucosal surfaces
      • Purpura fulminans, petechiae and ecchymoses
        • Purpura fulminans is coagulation of blood vessels under the skin with subsequent skin necrosis
      • Multi-organ failure
        • Altered mental status
        • Dyspnea and shortness of breath
        • Renal and hepatic failure
      • Shock
        • Hypotension, tachycardia
    • Diagnosis
      • Decreased platelet count
        • Due to consumption of platelets in microthrombi
      • Increased bleeding time
        • Decreased platelet count increases laboratory measure of time to platelet plug (primary hemostasis)
      • Increased PT and PTT
        • Consumptive use of clotting factors causes increased laboratory measurement of all coagulation times
      • Schistocytes (helmet cells)
        • Seen on peripheral blood smear
      • Increased D-dimer
        • Degradation (split) product of fibrin, due to increased breakdown of cross-linked fibrin
      • Decreased fibrinogen levels
        • Due to consumption of all clotting factors
      • Decreased factors V and VIII
        • Due to consumption of all clotting factors
    • Treatment
      • Treat underlying disorder
      • Supportive
        • Fluids
        • Blood products (PRBCs, platelets, FFP)