('''DIC''') is a
Pathological process in the body where the
Blood starts to
Coagulate throughout the whole body. This depletes the body of its
Platelet s and coagulation factors, and there is a paradoxically increased risk of
Haemorrhage . It occurs in critically ill patients, especially those with
Gram-negative Sepsis (particularly
Meningococcal sepsis) and
Acute Promyelocytic Leukemia .
There are a variety of causes of DIC, all usually causing the release of chemicals into the blood that instigates the coagulation.
- Sepsis, particularly with gram-negative bacteria.
- Tissue trauma such as burns, accidents, surgery or Shock .
- Obstetric complications, with chemicals from the Uterus being released into the blood, or from Amniotic Fluid Embolism s, and Eclampsia can be causes.
- Malignant cancers, or widespread tissue damage (e.g. burns), or Hypersensitivity reactions all can produce the chemicals leading to a DIC.
- Liver disease
- Incompabible blood transfusion reactions
- Envenomation by some venomous snakes such as the Stephens Banded Snake, '' Hoplocephalus Stephensi '' (from the family of Elapidae ).
Although numerous (especially the
Platelet count),
Fibrin Degradation Product s or
D-dimer tests (markers of
Fibrinolysis ),
Prothrombin Time or
INR and
Fibrinogen levels. Decreased platelets, elevated FDPs or D-dimers, high PT/INR and decreased fibrinogen are markers of DIC.
Various factors can activate the system of coagulation, but the end result is formation of
Fibrin , a mesh-like protein. The fibrin deposition can block blood vessels, leading to
Ischemic damage to some tissues. As well as this,
Red Blood Cell s are damaged as they get shredded by the fibrin, leading to
Microangiopathic Hemolytic Anemia (MAHA).
The underlying cause must be treated initially. Anticoagulants are not given, as by now all the coagulation factors and platelets have been used up. These must be replaced, by platelet
Transfusion and
Fresh Frozen Plasma , to restore normal levels.
DIC results in lower
Fibrinogen (as it has all been converted to fibrin), and this can be tested for in the
Hospital Lab . A more specific test is for "fibrin split products" (FSPs) or "fibrin degradation products" (FDPs) which are produced when fibrin undergoes degradation when blood clots are dissolved by
Fibrinolysis .
In some situations, infusion with
Antithrombin may be necessary. A new development is
Drotrecogin Alpha (Xigris®), a
Recombinant activated
Protein C product. Activated Protein C (APC) deactivates clotting
Factors V and
VIII , and the presumed mechanism of action of drotrecogin is the cessation of the intravascular coagulation. Due to its high cost, it is only used strictly on indication in
Intensive Care patients.
The prognosis for those with DIC, depending on its cause, is often grim, leading the acronym to be known colloquially as "death is coming"
{Link without Title} .
