Clinical features, diagnosis, and treatment of disseminated intravascular coagulation in adults
- Lawrence LK Leung, MD
Lawrence LK Leung, MD
- Editor-in-Chief — Hematology
- Section Editor — Disorders of Hemostasis and Coagulation
- Professor of Medicine
- Stanford University School of Medicine
Disseminated intravascular coagulation (DIC, also called consumption coagulopathy and defibrination syndrome) is a systemic process with the potential for causing thrombosis and hemorrhage. It can present as an acute, life-threatening emergency or a chronic, subclinical process, depending on the degree and tempo of the process and the contribution of morbidities from the underlying cause. Identifying DIC and the underlying condition responsible for it are critical to proper management.
This topic discusses the pathogenesis, clinical manifestations, diagnosis, treatment, and prognosis of DIC in adults. DIC in children and during pregnancy are discussed in detail separately. (See "Disseminated intravascular coagulation in infants and children" and "Disseminated intravascular coagulation during pregnancy".)
Separate topic reviews also discuss general approaches to evaluating patients with abnormal bleeding and unexplained microangiopathic hemolytic anemia and thrombocytopenia. (See "Approach to the adult patient with a bleeding diathesis" and "Approach to the patient with suspected TTP, HUS, or other thrombotic microangiopathy (TMA)".)
Intravascular coagulation and fibrinolysis — Normal hemostasis ensures formation of a blood clot at the site of vessel injury, followed by resolution of the clot to allow tissue repair. There are multiple feedbacks built into this system to prevent activation of coagulation in the absence of vessel injury and restrict the clot to the site of injury. (See "Overview of hemostasis".)
In DIC, the processes of coagulation and fibrinolysis become abnormally (and often massively) activated within the vasculature, leading to ongoing coagulation and fibrinolysis.
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- Intravascular coagulation and fibrinolysis
- Role of extracellular cell-free DNA and DNA-binding proteins
- Compensatory changes
- DIC versus other TMAs
- CAUSES OF DIC
- CLINICAL MANIFESTATIONS
- Acute versus chronic DIC
- - Acute DIC
- - Chronic DIC
- Bleeding and thrombosis
- Organ dysfunction
- Purpura fulminans
- Laboratory abnormalities
- DIAGNOSTIC EVALUATION
- DIFFERENTIAL DIAGNOSIS
- Treat the underlying cause
- Supportive measures
- Prevention/treatment of bleeding
- Prevention/treatment of thrombosis
- Purpura fulminans
- RESOLUTION OF ABNORMALITIES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS