Disseminated intravascular coagulation (DIC) is a serious condition that affects the blood clotting mechanisms of the body. The proteins involved in blood clotting are activated in an abnormal and uncontrollable fashion by various diseases. This can result in tissue damage and abnormal bleeding.
When a person is cut or bleeding from an injury, the blood must clot to stop him or her from bleeding to death. In order for blood to clot, a complex chain of events must occur. These events involve the activation, or "turning on," of certain proteins in the blood. In addition, special blood cells called platelets also help blood to form clots.
In DIC, platelets and the proteins that make blood clot are activated abnormally. DIC usually occurs due to another underlying disease or condition, such as cancer. Once the blood clotting mechanism is turned on in DIC, blood clots may form inside the bloodstream. These tiny blood clots can damage tissue by blocking blood flow through blood vessels. In addition, if the DIC persists, all of the blood clotting proteins may get "used up" or destroyed. This may lead to abnormal bleeding.
The three main symptom groups of DIC are: the symptoms of the underlying condition that caused the DIC, such as pregnancy, cancer, or serious illnessabnormal bleeding, usually from areas of recent injury or skin incisions, punctures, or cutssymptoms from abnormal blood clots, which may include leg pain from a blood clot in the leg, known as deep venous thrombosis. A person may also get cold fingers or toes from blood clots in these areas. Blood clots can also damage organs inside the body, such as the kidneys.
The most common causes of DIC are: pregnancy, which may cause DIC following a postpartum hemorrhage, when a complication causes fluid from the inside of the womb to get into the mother's bloodstream, or with toxemia of pregnancycancer serious infections, such as a blood infection known as sepsis severe head injury surgery, such as operations involving the prostate gland in mencertain poisonous snakebites
Prevention is usually not possible, but is related to the cause. For instance, following sports safety guidelines for children, adolescents, and adults could prevent some cases due to head injury. Early treatment of infections with antibiotics may stop them from getting severe enough to cause DIC. Avoidance of snakes can help prevent snakebites.
Diagnosis of DIC begins with the history and physical exam. DIC is usually suspected when a person with a condition known to cause DIC has abnormal bleeding or blood clots. In most cases, the diagnosis is confirmed with blood tests. A series of blood tests, often called a DIC panel, can be ordered when this condition is suspected. The blood tests measure various parts of the clotting mechanism and count the number of cells in the blood.
DIC is a serious condition that can cause permanent organ damage and death. If the underlying cause can be corrected, DIC may go away and cause no long-term effects.
DIC is not contagious and poses no risks to others. If the underlying cause of DIC is an infection, the infection may be contagious.
Treatment is directed at the underlying cause when possible. For instance, a pregnant woman may need an urgent cesarean section to deliver her baby. Someone with a severe illness may need antibiotics. Someone with cancer may need chemotherapy or radiation therapy.
Treatment can also be given for the DIC itself, if needed. A person with abnormal bleeding can be given blood transfusions to replace the platelets and other proteins that help blood to clot. Someone with abnormal blood clots can be given medications to thin the blood, called blood thinners or anticoagulants. An example of a blood thinner is a medication called heparin.
Side effects depend on the treatments used. A Cesarean birth (C-section), like any surgery, carries a risk of bleeding, infection, or reactions to anesthesia. Antibiotics may cause allergic reactions and stomach upset. Blood thinners such as heparin may cause abnormal bleeding or allergic reactions. The benefits of treatment almost always outweigh the risks, as DIC can result in organ damage or death.
If the underlying cause can be corrected, the DIC usually goes away. In this case, a person may need no further treatment or monitoring if organ damage has not occurred. If the underlying cause cannot be corrected, such as a cancer that has spread throughout the body, treatment often does not stop. Death may result if treatment is unsuccessful.
Repeat blood tests are often used to monitor the status of the body's blood clotting mechanisms. Other monitoring is related to the cause of the DIC.
Harrison's Principles of Internal Medicine, 1997, Fauci et al.
