Disseminated Intravascular Coagulation (DIC)

Briaunna Minor

Definition

Simultaneous systemic coagulation activation, dysregulated fibrinolysis, and microvascular damage resulting in microthrombosis. Diffuse deposition of intravascular platelets and fibrin + consumption of coagulation factors and thrombocytes → end organ ischemia and excessive bleeding. Per updated literature, DIC can be stratified into thrombotic phenotype and hemorrhagic phenotype based precipitating etiologies (ISTH SCC DIC 2025).


Etiologies: Sepsis, Liver Disease, Pancreatitis, Trauma, Malignancy (ALL, APML, Metastatic Adenocarcinomas), Acute Hemolytic Transfusion Reactions, Obstetric Complications	Exam Findings: petechiae, gingival bleeding, hematuria, IV or surgical wound site bleeding, ecchymoses, cold or pulseless extremities. Lab Evaluations: CBC, PT-INR, aPTT, Fibrinogen, D-Dimer, Hemolysis Labs, Peripheral Blood Smear, Factor VIII Lvl (distinguish from liver failure) Dx: ↓ PLT, ↑ INR, ↑ aPTT, ↓ Fibrinogen, ↑ LDH, ↓ Haptoglobin, ↓ FVIII, + Schistocytes Tools: DIC score, SIC Score
DIC Management: Trend PT-INR, aPTT, Fibrinogen Q6H (deescalate with lower risk) Tx: ultimately address underlying cause
Thrombotic Phenotype (VTE): Anti-Coagulate (PLT > 50 and no massive bleeding underway) Hemorrhagic Phenotype: INR > 1.7 - Vitamin K 10 mg Fibrinogen < 100 - Cryo 5-10 units Fibrinogen > 100 and INR > 2 - FFP PLTs < 10k or < 50k with severe bleeding - PLTs

Etiologies: Sepsis, Liver Disease, Pancreatitis, Trauma, Malignancy (ALL, APML, Metastatic Adenocarcinomas), Acute Hemolytic Transfusion Reactions, Obstetric Complications

Exam Findings: petechiae, gingival bleeding, hematuria, IV or surgical wound site bleeding, ecchymoses, cold or pulseless extremities.

Lab Evaluations: CBC, PT-INR, aPTT, Fibrinogen, D-Dimer, Hemolysis Labs, Peripheral Blood Smear, Factor VIII Lvl (distinguish from liver failure)

Dx: ↓ PLT, ↑ INR, ↑ aPTT, ↓ Fibrinogen, ↑ LDH, ↓ Haptoglobin, ↓ FVIII, + Schistocytes

Tools: DIC score, SIC Score

DIC Management: Trend PT-INR, aPTT, Fibrinogen Q6H (deescalate with lower risk)
Tx: ultimately address underlying cause

Thrombotic Phenotype (VTE):
Anti-Coagulate (PLT > 50 and no massive bleeding underway)

Hemorrhagic Phenotype:
INR > 1.7 - Vitamin K 10 mg
Fibrinogen < 100 - Cryo 5-10 units
Fibrinogen > 100 and INR > 2 - FFP
PLTs < 10k or < 50k with severe bleeding - PLTs