Disseminated intravascular coagulation

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Key diagnostic factors

common

presence of underlying disorders

An underlying disorder is required for consideration of disseminated intravascular coagulation (DIC) and can include major trauma/burns/organ destruction, sepsis/severe infection (including severe coronavirus disease 2019 [COVID-19] infection), severe obstetric disorders or complications, solid tumours and haematological malignancies, severe toxic or immunological reactions, and major vascular disorders (large aortic aneurysms or giant haemangiomas).[1][2][3]

The symptoms/signs related to a specific underlying condition/disease differ due to the variety of disorders associated with DIC. However, their presence indicates that the patient is at risk for development of DIC.

oliguria, hypotension, or tachycardia

Systemic signs/symptoms of circulatory collapse, which may be associated with DIC.

purpura fulminans, gangrene, or acral cyanosis

Systemic signs of microvascular/macrovascular thrombosis, which may be associated with DIC.

delirium or coma

Systemic signs/symptoms of microvascular/macrovascular thrombosis, which may be associated with DIC.

petechiae, ecchymosis, oozing, or haematuria

Generalised bleeding, evidenced by at least three unrelated sites, is highly suggestive of DIC.

Risk factors

strong

major trauma/burn/organ destruction or sepsis/severe infection

A systemic inflammatory response and tissue or infectious material released into the circulation leads to activation of the cytokine network and coagulation pathway.[1][2]

severe obstetric disorders or complications

Release/exposure of tissue material into circulation leading to activation of the external coagulation (factor VIIa) pathway.[1][2]

solid tumours and haematological malignancies

Release of tissue material and tumour-expressed procoagulants such as tissue factor or cysteine protease into circulation, leading to systemic activation of coagulation.[1][2]

severe toxic or immunological reactions

Snake bites, drugs, blood transfusion reactions, and transplant rejection can cause release or exposure of lipid membrane material to circulation and activation of cytokine network, leading to systemic activation of coagulation systems.[1][2]

weak

major vascular disorders (large aortic aneurysms or giant haemangiomas)

Local activation of coagulation leading to release of activated coagulation factor into the systemic circulation and the systemic depletion of coagulation factors and platelets.[1][2]

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