Blood Transfusion in DIC
Blood transfusion is indicated in DIC patients with active bleeding or those at high risk of bleeding undergoing invasive procedures, but should NOT be given solely to correct laboratory abnormalities in non-bleeding patients, as this may worsen disseminated thrombosis without improving clinical outcomes. 1
Indications for Platelet Transfusion
Active bleeding:
- Transfuse platelets to maintain count >50 × 10⁹/L in patients with DIC and active hemorrhage 1, 2, 3
High bleeding risk (surgery/invasive procedures) without active bleeding:
- Transfuse if platelets <30 × 10⁹/L in acute promyelocytic leukemia (APL) 1, 2
- Transfuse if platelets <20 × 10⁹/L in other cancers or DIC etiologies 1, 2
- One to two doses (commonly from five donors or equivalent) are typically administered 1
Important caveat: The lifespan of transfused platelets may be extremely short in DIC with vigorous coagulation activation, requiring frequent monitoring to determine need for additional replacement 1, 2, 4
Indications for Fresh Frozen Plasma (FFP)
Active bleeding with coagulopathy:
- Administer FFP (15-30 mL/kg) in patients with active bleeding AND prolonged PT/PTT ratios (>1.5 times normal) or decreased fibrinogen (<1.5 g/L) 1, 2, 3
- Monitor carefully for volume overload and adjust dosing accordingly 1, 2
Alternative to FFP:
- Consider 4-factor prothrombin complex concentrate (4F-PCC) instead of plasma in severe coagulopathy with bleeding to prevent significant volume overload 1
- Note that factor concentrates only partially correct the defect as they contain selected factors, whereas DIC causes global coagulation factor deficiency 3
Indications for Fibrinogen Replacement
Persistent severe hypofibrinogenemia:
- Administer cryoprecipitate (two pools) or fibrinogen concentrate when fibrinogen remains <1.5 g/L despite FFP administration in actively bleeding patients 1, 2, 3
Critical Contraindications
Do NOT transfuse in non-bleeding patients solely to correct laboratory values:
- Transfusions given only to normalize laboratory abnormalities in the absence of bleeding may worsen disseminated thrombosis and deplete blood product resources without evidence of improving clinical outcomes 1
- Correction of coagulopathy in unselected patients without significant bleeding is not recommended 1
Monitoring Requirements
- Frequent blood monitoring is essential to determine thresholds and need for further replacement therapy, as transfused products have shortened survival in DIC 1, 2
- A platelet count decline >30% from baseline may indicate subclinical DIC progression requiring closer monitoring 1, 2, 4
Treatment Priority Framework
The fundamental principle remains that treating the underlying cause of DIC is the cornerstone of management 1, 2, 3, 5. Blood product transfusion is supportive care that should be guided by clinical bleeding manifestations and bleeding risk, not laboratory values alone 1, 3.