What is Disseminated Intravascular Coagulation?

Disseminated intravascular coagulation (DIC) is not an independent disease, but the ultimate common pathway for coagulation dysfunction in the progression of many diseases. It is a clinicopathological syndrome. Because the blood coagulation mechanism is diffusely activated, extensive fibrin deposition in small blood vessels is induced, resulting in tissue and organ damage; on the other hand, systemic bleeding tends to occur due to the consumption of coagulation factors. The two contradictory manifestations coexist during the development of DIC disease and constitute unique clinical manifestations. Multiple organ dysfunction syndrome will be the leading cause of death in patients whose DIC has been activated. No morbidity has been reported in China. The mortality rate of DIC is as high as 31% to 80%.

Basic Information

English name

disseminated intravascular coagulation; DIC

Visiting department

Emergency, Infectious Diseases, Obstetrics and Gynecology, Pediatrics

Common causes

Caused by infectious diseases, malignant tumors, obstetric diseases and trauma

Common symptoms

Bleeding, thromboembolism, shock, impaired organ function

Contagious

no

Causes of disseminated intravascular coagulation

The cause of DIC comes from underlying diseases. Infectious diseases and malignant diseases account for about two thirds, and obstetric disasters and traumas are also the main causes of DIC.

The basic diseases that induce DIC include: systemic infections / severe infections, including bacteria, viruses, parasites, rickettsia, etc. Trauma, including multiple trauma, large-scale burns, fat embolism, etc. Organ damage, see severe pancreatitis. Malignant tumors, including various solid tumors, leukemias, and myeloproliferative diseases. Obstetric disasters, including amniotic fluid embolism, placental abruption, stillbirth syndrome, etc. Others, such as severe liver failure, severe poisoning or snake bite, blood transfusion reaction, organ transplant rejection reaction, etc.

Clinical manifestations of disseminated intravascular coagulation

Clinical manifestations are related to underlying diseases. What kind of proteolysis (coagulation or fibrinolysis) is dominant in DIC will largely determine the characteristics of clinical manifestations. Patients with predominant coagulation may only show thromboembolic DIC; those with fibrinolysis may develop acute wasting bleeding. A broad spectrum of clinical manifestations involving different types of DIC can also be presented between the above.

Bleeding

Multi-site bleeding often predicts acute DIC. Skin purpura, ecchymosis, and bleeding at the puncture site or injection site are more common. Continuous bleeding and non-coagulation of the wound site during or after the operation.

Thromboembolism

Microthrombosis of various organs is caused by thrombosis of small arteries, capillaries or small veins, resulting in insufficient organ perfusion, ischemia or necrosis. Hemorrhagic dead spots at the end of the skin; gangrene of the fingers or toes.

3. shock

Both the underlying disease of DIC and the disease itself can induce shock.

4. Impaired organ function

Important organs Renal damage rate is 25% to 67%, which is manifested as hematuria, oliguria, or even anuria; Central nervous system dysfunction is manifested by altered consciousness, convulsions, or coma; respiratory function is affected by pulmonary hemorrhage, varying degrees Oxygenemia; gastrointestinal bleeding in the digestive system; 22% to 57% of liver dysfunction, jaundice, liver failure.

Disseminated intravascular coagulation test

1. Commonly used fast and easy laboratory screening tests include: platelet count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, D-dimer.

2. DIC special examination is suitable for those who cannot be diagnosed after screening.

Diffusion intravascular coagulation diagnosis

General criteria for DIC diagnosis:

1. There are underlying diseases that are prone to DIC

Whether it is a domestic or foreign diagnostic standard, the existence of underlying diseases is extremely important. Care should be taken if the underlying disease diagnosis of DIC is not clearly induced. Such as infections, malignant tumors, major surgery or trauma, pathology and obstetrics.

2. Has more than two clinical manifestations

(1) Tendency to severe or multiple bleeding.

(2) Microcirculation disorder or shock that cannot be explained by the primary disease.

(3) Extensive skin and mucosal embolism, focal ischemic necrosis, shedding and ulcer formation, or failure of organs such as the lung, kidney, and brain of unknown cause

(4) Anticoagulant therapy is effective.

3. The laboratory meets the following conditions

(1) At the same time, there are three or more of the following experimental abnormalities: platelet count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen level, D-dimer, etc.

(2) Special inspection for difficult or special cases.

Disseminated intravascular coagulation

Because the precipitating factors of DIC and the severity of clinical manifestations vary, treatment decisions should be individualized.

1. Basic disease treatment

Strengthening the treatment of basic diseases is the first measure to reduce the DIC-promoting factors and increase patient survival.

2. Application of blood products

The use of blood products is actually an alternative treatment. These include concentrated platelet suspensions, fresh frozen plasma, cryoprecipitates, fresh whole blood, prothrombin complexes, and more.

3. Heparin application

Heparin treatment may benefit some patients with chronic DIC. It is also used in patients with acute DIC and should be used with caution.

4. Fibrinolytic inhibitor

Use caution when applying.

Prognosis of disseminated intravascular coagulation

The mortality of DIC is as high as 31% to 80%. Because the etiology of DIC is a variety of different underlying diseases, it is more important to understand and understand the underlying diseases and the overall clinical manifestations.