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Disseminated Intravascular Coagulation (DIC)

Disseminated intravascular coagulation (DIC), also referred to as consumptive coagulopathy, is a life-threatening blood condition that causes massive coagulation throughout the body. When a patient suffers from DIC, the condition significantly alters all of the components of his bloodstream. Specifically, thrombin and plasmin (two enzymes vital to controlling blood coagulation) flood the system. While thrombin promotes coagulation, plasmin works to prevent the clotting process.

Ironically, because the extensive clotting caused by DIC uses many of the body’s blood platelets, these patients also experience extensive hemorrhaging in various parts of their bodies.

Approximately 18,000 cases of disseminated intravascular coagulation occur in the United States each year. While DIC can occur in patients of either gender and of any age, this condition typically affects those already suffering from more serious health problems, such as meningococcal sepsis (a type of blood infection) and acute promyelocytic leukemia (blood and bone marrow cancer).

Disseminated Intravascular Coagulation Causes

DIC is a condition that generally occurs in response to another underlying health condition. The following are just some of the conditions that trigger disseminated intravascular coagulation:

adverse reactions to anesthetics
adverse reactions to blood transfusions
adverse reactions to shunts (devices used to enlarge blood vessels)
aortic aneurisms
burns
cancers
Crohn's disease (a disorder marked by an inflamed digestive tract)
eclampsia (hypertension in pregnant women that can cause coma or, in the worst cases, death)
heart attack
leukemia
malaria and other parasitic diseases
massive trauma
placental abortion
Raynaud disease (a blood vessel condition that generally affects sensation in the body’s extremities)
rheumatoid arthritis
sepsis (a severe bacterial infection in the bloodstream)
severe liver disease
some snake venoms
surgery
ulcerative colitis (a condition marked by ulcers, or sores, along the colon).

Symptoms of DIC

Disseminated intravascular coagulation may be:

acute (a condition that lasts only a short time)
chronic (a recurring condition)
localized (a condition that only affects a specific area of the body).

DIC symptoms may include any of the following:

bleeding from three or more sites
blood clot formation
confusion
disorientation
dyspnea (difficulty breathing)
fever
hematuria (blood in urine)
irregular heartbeat
necrosis (localized cell death)
signs of kidney failure
spontaneous bruising
stupor (a state of non-responsive consciousness).

Given the fact that another serious condition causes DIC, other symptoms particular to the underlying condition may also be present.

DIC Prognosis and Diagnosis

While the outlook for disseminated intravascular coagulation depends in part on the underlying cause, in most cases, the prognosis is grim. DIC mortality rates approach 50 percent, depending on the cause.

The mortality rate for physical trauma doubles if DIC accompanies the initial trauma. However, prompt diagnosis and treatment of disseminated intravascular coagulation improves the chances of survival.

Unfortunately, no single test can properly diagnose DIC. Diagnosis depends on the presence of symptoms, as well as the results of a number of blood tests that measure coagulation and anticoagulation factors.

DIC Treatments

Because DIC is a symptom of other conditions, successful treatment of it relies on treating the underlying health problem. If the underlying cause of disseminated intravascular coagulation is not resolved, DIC symptoms will persist and likely worsen.

As the underlying cause of DIC is treated, treatment for DIC focuses on preventing or minimizing the life-threatening symptoms of this condition, specifically severe bleeding and compromised breathing.

Blood clots caused by DIC can be treated with anticoagulant medications (blood thinners), such as heparin and warfarin. However, because disseminated intravascular coagulation also causes extensive bleeding, taking these blood thinner medications to prevent massive clotting must be balanced against the risk of hemorrhaging.

Along with taking medication, treatment for DIC also includes transfusions of blood compounds. These blood transfusions may include:

antithrombin III (a compound that helps control coagulation)
cryoprecipitate
plasma
platelet concentrations
red blood cell transfusions.

DIC Complications

Thrombin overload causes blood clots in both the major and minor blood vessels, causing a condition known as deep vein thrombosis (DVT). Both arteries and veins are susceptible to developing these blood clots. Because thrombosis caused by DIC severely reduces the flow of blood to the vital organs, this condition can cause organ damage and, if left untreated, organ failure.

Other serious complications of DIC include:

cardiac tamponade (compression of the heart due to surrounding blood)
gangrene
hemothorax (bleeding in the abdomen)
intracerebral hemotoma (blood clots in the brain due to ruptured blood vessels)
life-threatening bleeding
life-threatening blood clots
stroke
the need for amputation (especially of the digits).

Resources

Furlong, M. (2007). Disseminated Intravascular Coagulation. Retrieved September 21, 2007, from the eMedicine Web site: www.emedicine.com/emerg/topic150.htm.

Merck Manuals Online Medical Library (2006). Disseminated Intravascular Coagulation (DIC). Retrieved September 21, 2007, from the Merck Web site: www.merck.com/mmhe/

sec14/ch173/ch173h.html.

U.S. National Library of Medicine. (2007). Disseminated Intravascular Coagulation (DIC). Retrieved September 21, 2007, from the MedlinePlus Web site: www.nlm.nih.gov/medlineplus/ency/article/000573.htm.