Symptoms of Disseminated Intravascular Coagulation (DIC)
DIC presents with two primary clinical manifestations—bleeding and thrombosis—which can occur simultaneously or separately depending on the underlying disease and the dominant pathophysiologic mechanism. 1
Three Clinical Phenotypes
DIC manifests in three distinct patterns that determine symptom presentation 1, 2:
1. Procoagulant (Thrombotic) DIC
This phenotype is characterized by thrombotic complications rather than bleeding. 1
Arterial thrombotic manifestations include:
- Uneven, patchy skin discoloration 1
- Poor digital circulation and digital ischemia 1
- Cerebrovascular events (stroke) 1
- Peripheral neuropathy 1
- Ischemic colitis 1
Venous thrombotic manifestations include:
This phenotype is most commonly seen with pancreatic cancer and adenocarcinomas. 1
2. Hyperfibrinolytic (Bleeding) DIC
This phenotype is dominated by severe hemorrhagic complications. 1
Bleeding manifestations include:
- Widespread bruising and ecchymoses 1
- Bleeding from mucosal surfaces 1
- Central nervous system hemorrhage 1
- Pulmonary hemorrhage 1
- Gastrointestinal bleeding 1
- Bleeding from sites of trauma or venipuncture 1
This phenotype is characteristic of acute promyelocytic leukemia and metastatic prostate cancer, where hemorrhage is the most common cause of early mortality and catastrophic bleeding can occur before diagnosis is even established. 1
3. Subclinical DIC
This phenotype has no obvious clinical symptoms or signs—only laboratory abnormalities. 1, 2
Patients appear asymptomatic but have ongoing consumptive coagulopathy that may worsen or improve depending on the underlying malignancy. 1
Organ Dysfunction from Microvascular Thrombosis
DIC causes multiorgan failure from widespread micro- and macrovascular thrombi ("disseminated coagulation"). 1
This distinguishes DIC from other coagulopathies and represents a critical feature affecting morbidity and mortality. 1
Critical Diagnostic Pitfall
A key clinical caveat: patients may have normal absolute platelet counts yet still have active DIC if their baseline was elevated. 1, 3
A profound decrease from very high platelet levels (even if still in the normal range) may be the only clinical sign of DIC in some malignancy patients and should never be discounted as unimportant. 1, 3 This is particularly crucial in hematological cancers where marrow failure and chemotherapy affect platelet counts—a decreasing trend should always be considered a marker of continuing thrombin generation. 1
Dynamic Nature of Symptoms
DIC symptoms evolve rapidly (hours to days), which is a sine qua non feature distinguishing it from chronic liver disease. 1
The rapid changes in both clinical manifestations and laboratory parameters are essential for diagnosis and reflect the acute consumptive process. 1
Underlying Trigger Always Present
DIC never occurs in isolation—there is always an underlying trigger condition. 1, 2, 3
The most common triggers are sepsis, malignancy, trauma, major surgery, and obstetric complications. 2, 3, 4 Recognizing the underlying disease is essential because symptoms may reflect both the DIC process and the precipitating condition. 1, 5