From the Guidelines
Disseminated Intravascular Coagulation (DIC) is characterized by a range of symptoms including unexplained bleeding, skin manifestations, and internal bleeding leading to organ dysfunction, with the most recent evidence suggesting that it presents with both excessive clotting and bleeding simultaneously 1. The symptoms of DIC can vary widely, but common manifestations include:
- Unexplained bleeding from multiple sites such as nosebleeds, bleeding gums, blood in urine or stool, and excessive bleeding from wounds or venipuncture sites
- Skin manifestations including petechiae (small red or purple spots), ecchymoses (bruising), and purpura (larger purple patches)
- Internal bleeding leading to organ dysfunction, with symptoms like shortness of breath, chest pain, abdominal pain, altered mental status, seizures, or coma DIC typically occurs secondary to another condition such as sepsis, trauma, malignancy, or obstetric complications, and the underlying pathophysiology involves widespread activation of coagulation pathways, leading to consumption of clotting factors and platelets, which paradoxically results in both thrombosis (small blood clots throughout the body) and hemorrhage, as noted in recent studies 1. Laboratory findings typically show prolonged clotting times, decreased fibrinogen levels, elevated D-dimer, and thrombocytopenia, and treatment focuses on addressing the underlying cause while providing supportive care with blood products as needed, with the most recent guidelines emphasizing the importance of early detection and management of endothelial dysfunction in DIC 1. Some key laboratory measurements that can aid in the diagnosis and management of DIC include:
- FVIII and VWF levels, which can serve as a confirmatory test of a consumptive process
- AT levels, which can aid in clinical management, for example, in patients with renal failure
- D-dimer, which can be a nonspecific biomarker of systemic fibrinolytic activity, but should be interpreted with caution in patients with ascites, as noted in recent studies 1.
From the Research
Symptoms of Disseminated Intravascular Coagulation (DIC)
The symptoms of DIC can vary depending on the severity and underlying cause of the condition. Some common symptoms include:
- Bleeding, which can range from mild to severe 2
- Thrombosis, which can occur in less than 10% of acute cases but is more frequent in chronic DIC associated with malignancy 2
- Microangiopathic hemolytic anemia, which can lead to symptoms such as fatigue, weakness, and shortness of breath 3, 4
- Hypoxic multiorgan dysfunction syndrome, which can cause symptoms such as confusion, disorientation, and organ failure 3
- Acute renal failure, which can cause symptoms such as decreased urine output, swelling, and fatigue 4
- Transient focal neurologic deficit, delirium, or coma 4
Clinical Manifestations
The clinical manifestations of DIC can be divided into two types: acute (non-compensated) and chronic (compensated) 4. Acute DIC is characterized by severe clinical manifestations, such as bleeding, shock, and acute renal failure. Chronic DIC, on the other hand, is characterized by alteration of laboratory values and may not always present with severe clinical symptoms.
Laboratory Findings
The laboratory findings of DIC can include:
- Abnormalities in prothrombin time, platelet count, fibrinogen, and fibrinogen/fibrin degradation products 2
- Elevated D-dimer levels 4
- Thrombocytopenia, which can be a sign of consumptive thrombocytopenia 3, 4
- Microangiopathic hemolytic anemia, which can be characterized by the presence of fragmentocytes and helmet cells in the peripheral blood 4