DIC

Most Common Etiologies

• Top three etiologies: infection, malignancy, and trauma/surgery, each account for 10-20% of cases.
• Bacterial sepsis (83%), Trauma (31%), Cancer (e.g. APML, 6.8%), placental abruption, preeclampsia, amniotic fluid embolism, burn, hyperthermia, rhabdomyolysis, infection, transfusion reaction (ABO incompatibility), snake venom, aortic aneurysm

Pathogenesis

• Exposure: Expression of the transmembrane glycoprotein TF (which activates factor VII and the extrinsic pathway)
• Coagulation: Consumption of clotting factors; Widespread micro and macrovascular thrombosis, depletion of fibrinogen and fibrin clot formation; Platelets are trapped in the clots
• Fibrinolysis: Plasminogen --> Plasmin also upregulated, leading to large increase in clot breakdown and release of FDPs such as D-dimer. Leads to worsened bleeding.

Diagnostic Algorithm

Score of 5+ points strongly associated with DIC

• Presence of a disease known to be associated with DIC (2 pts)
• Platelets < 100k (1 pt), < 50k (2 pt)
• Fibrin degradation products (FDPs) (e.g. d-dimer): moderate increase (2 pt), strong increase (3 pt)
• PT > 3s (1 pt), > 6s (2 pt)
• Fibrinogen < 1 g/L (1 pt)

Compared with the non-DIC group, the DIC group had prolonged K time, decreased α angle, increased R value, and decreased CI and MA value (P<0.05). With increase of SOFA scores, R value and K value increased significantly, and α angle, MA value, and CI decreased significantly (P<0.05). According to TEG, platelet function and fibrinogen function of DIC patients were significantly reduced, and the body showed hypocoagulability. (PMID: 30988714)

Treatments

• Basically don't get it.
• Treat underlying condition
• Treatment is lousy. Evidence behind treatment is likewise lousy.
• Platelets, cryo, FFP

Mortality

• 20-50%