Which of the following statements about Disseminated Intravascular Coagulation (DIC) is not true?

Which Statement About DIC is Not True?

The statement that laboratory results indicate increased platelet, increased fibrinogen, and prolonged PT/INR is not true in DIC. 1

Understanding DIC Pathophysiology

Disseminated Intravascular Coagulation (DIC) is a complex clinicobiological syndrome characterized by widespread activation of coagulation leading to:

1. Consumption of clotting factors and platelets - Not increased levels
2. Simultaneous clotting and bleeding - A hallmark feature
3. Organ dysfunction due to microvascular thrombosis

Laboratory Findings in DIC

The typical laboratory profile in DIC shows:

• Decreased platelets (thrombocytopenia) due to consumption in microthrombi formation 2, 1
• Decreased fibrinogen (hypofibrinogenemia) due to consumption in clot formation 1
• Prolonged PT/INR and aPTT due to consumption of clotting factors 1
• Elevated D-dimer or fibrin degradation products (FDPs) due to secondary fibrinolysis 2

Serial measurements showing worsening of these parameters are particularly diagnostic of DIC, with the International Society on Thrombosis and Haemostasis (ISTH) scoring system providing objective criteria for diagnosis 1.

Examining Each Statement

Let's analyze each statement in the question:

1. "Results from activation of the clotting cascade and results in clotting factor consumption" - TRUE. DIC is characterized by systemic activation of coagulation with consumption of platelets and coagulation proteins 3.

2. "Diffuse clotting occurs simultaneously with bleeding" - TRUE. DIC features both thrombotic obstruction of small and midsize vessels AND hemorrhagic complications due to consumption of platelets and clotting factors 3.

3. "Heparin may improve lab parameters, but may aggravate bleeding" - TRUE. Heparin has been used in DIC management, particularly in prothrombotic forms, but carries bleeding risk, especially with low platelet counts 2.

4. "Lab results indicate increased platelet, increased fibrinogen, and prolonged PT/INR" - FALSE. DIC is characterized by decreased (not increased) platelets and fibrinogen, along with prolonged PT/INR 1.

Clinical Implications

Understanding the correct laboratory profile of DIC is crucial for:

• Early diagnosis and intervention
• Monitoring disease progression
• Guiding appropriate treatment decisions

DIC always occurs secondary to an underlying condition (sepsis, malignancy, trauma, obstetric complications), and management must address both the underlying cause and the coagulopathy 1, 3.

Common Pitfalls in DIC Diagnosis

• Mistaking DIC for liver disease (which can have similar lab findings but more stable parameters)
• Focusing on a single lab value rather than the dynamic pattern of changes
• Failing to recognize that DIC can present with different subtypes (procoagulant, hyperfibrinolytic, or subclinical) 1
• Overlooking DIC in patients with normal fibrinogen (as fibrinogen is an acute phase reactant and may be elevated at baseline) 4