Definition

Disseminated Intravascular Coagulation (DIC) is a rare yet serious condition characterized by abnormal blood clotting throughout the body's blood vessels. DIC can occur as a result of infections or injuries that disrupt the body's normal blood clotting process.

Causes

DIC is typically triggered by inflammation from infections, injuries, or specific medical conditions. Approximately 10% of individuals with chronic illnesses like sepsis, cancer, or pancreatitis (inflammation of the pancreas), as well as those recuperating from severe injuries such as burns or complications during pregnancy and childbirth, may develop DIC.

When an injury occurs, clotting proteins migrate to the site to stop bleeding. However, DIC can develop if these proteins become overly active throughout the body. Underlying causes often involve inflammation, infection, or cancer.

DIC develops in two stages: hypercoagulation followed by bleeding.

• During the initial stage, hypercoagulation prompts the formation of blood clots throughout the blood vessels. Some clots can obstruct blood vessels, disrupting normal blood flow to vital organs such as the liver, brain, or kidneys. The compromised blood supply can inflict significant damage and injury to these organs.
• In the subsequent stage, as DIC progresses, the hypercoagulation process depletes many blood platelets and clotting factors essential for normal blood clotting in response to injury or bleeding. Without an adequate supply of platelets and clotting factors, individuals are at heightened risk of severe bleeding, even from minor injuries or in the absence of any injury. Additionally, spontaneous bleeding can occur without any triggering event. Moreover, the condition can lead to healthy red blood cells rupturing as they traverse through small blood vessels occluded by blood clots.

Read more : Pancreatitis - Definition, Causes, Symptoms, and Management 

Risk factor

Several factors can increase the risk of DIC include: 

• Blood infections, particularly those triggered by bacteria or fungi.
• Sepsis, a severe systemic response to infection characterized by inflammation, is the most common risk factor for DIC.
• Severe organ or tissue damage, as seen in conditions like liver cirrhosis, pancreatitis, major injuries, burns, or extensive surgeries.
• Reactions to blood transfusions, where the body may excessively react to failed transfusions, organ transplant rejections, or toxins like snake venom.
• Serious pregnancy-related disorders including placental abruption before delivery, amniotic fluid embolism, retained placenta post-delivery, or significant bleeding during or after childbirth.
• Certain cancers, particularly specific types of leukemia.
• Large hemangiomas, abnormal blood vessels.

DIC is a rare complication of COVID-19. Individuals experiencing DIC are more prone to severe complications, such as organ failure, which can be life-threatening.

Read more: Hemangioma - Definition, Causes, Symptoms, and  Management

Symptoms

Symptoms of DIC may include:

• Bleeding from wounds or the nose, gums, or mouth
• The presence of blood in the stool or urine
• Bruising, ranging from small spots to larger patches on the body
• Chest pain
• Pain, redness, warmth, and swelling in the legs
• Decreased blood pressure
• Shortness of breath
• Confusion, memory impairment, or behavioral changes
• Fever

Diagnosis

Diagnosis of DIC relies on your medical history, physical examination, and diagnostic tests. Identifying the underlying causes of DIC is important, as it typically doesn't occur spontaneously.

Medical History and Physical Examination: Your doctor will inquire about recent medical conditions or events that could predispose you to DIC, such as illness or injury. A physical examination will detect signs of blood clotting, bleeding, or conditions associated with DIC or its complications.

• Blood Tests: If DIC is suspected, your doctor may recommend several blood tests, including:
• Complete blood count with blood smear
• Partial thromboplastin time (PTT)
• Prothrombin time (PT), measuring blood clotting time
• Fibrinogen test, assessing fibrinogen levels in the blood
• D-dimer test, detecting blood clots

Your doctor may employ a scoring system to diagnose DIC based on the test results. A higher score indicates a greater likelihood of DIC. Confirming the diagnosis may involve repeating tests and monitoring your condition over time.

• Tests for Other Medical Conditions: Additional tests or procedures may be recommended to rule out other conditions contributing to your symptoms. These tests may include:
• ADAMTS13 testing to assess the level and activity of this protein in the blood, which may be diminished in thrombotic thrombocytopenic purpura.
• Liver biopsy and liver function tests to evaluate for liver cirrhosis or chronic liver disease, which can mimic DIC symptoms.

Read more: Protrombin Period Inspection (PT/INR) - Indication, Contraindication, Results And Suggestions

Management

Management of DIC is tailored to your symptoms and the severity of your condition. The primary objective is to regulate blood clotting and bleeding while addressing underlying causes. DIC often resolves once these causes are treated. Meanwhile, doctors may prescribe medications or perform procedures to halt bleeding.

• Medications: Anticoagulants, or blood thinners, may diminish blood clotting. These medications can be administered orally, via injections, or infusions. Potential side effects include bleeding, particularly if you're also taking other blood-thinning medications like aspirin.
• Procedures and Therapies: Common treatment options encompass:
• Replacement therapy for clotting factors
• Plasma transfusion
• Platelet transfusion

Complications

Without intervention, DIC can give rise to complications stemming from both excessive blood clotting and subsequent bleeding, which can be life-threatening. These complications may encompass:

• Acute respiratory distress syndrome
• Gastrointestinal bleeding
• Heart attack
• Shock
• Stroke
• Venous embolism

Read more: Vena Embolism - Definition, Causes, Symptoms, and  Management

Prevention

DIC is linked to medical conditions such as cancer, pancreatitis, and liver disease. Regrettably, this implies there's limited scope for preventing DIC. However, you can empower yourself by familiarizing yourself with the signs and symptoms of DIC. Early recognition enables prompt treatment if you encounter conditions that may precipitate DIC.

When to see a doctor?

DIC (Disseminated Intravascular Coagulation) can pose a life-threatening risk. If you are undergoing treatment for sepsis, cancer, or experiencing complications after childbirth, and you encounter unexplained bleeding or bleeding that persists despite efforts to stop it, it's crucial to seek immediate medical attention. Head to the emergency department or call your local emergency number without delay.

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