Disseminated intravascular coagulation

Systemic activation of coagulation (often via tissue factor or widespread endothelial injury) produces fibrin‑rich microthrombi with consumption of platelets and clotting factors, leading to both thrombosis and diffuse bleeding.

• Rapidly fatal if untreated; hallmark lab pattern and broad differential show up frequently on exams.

• Acutely ill patient with bleeding from venipuncture/lines, ecchymoses, or oozing wounds.
• Common precipitants: sepsis (especially gram‑negative), obstetric emergencies (placental abruption, amniotic fluid embolism, retained dead fetus), trauma, malignancy (esp. acute promyelocytic leukemia), severe pancreatitis, snakebite, massive transfusion.
• Labs: ↓ platelets, prolonged PT and PTT, ↓ fibrinogen, ↑ D‑dimer, schistocytes.

1. Treat the underlying trigger (e.g., control infection, deliver placenta, start ATRA for APL).
2. Supportive products for bleeding: platelets, FFP, and cryoprecipitate (fibrinogen).
3. If thrombosis predominates and bleeding is controlled, heparin can be considered case‑by‑case.
4. Differentiate from liver disease: factor VIII is consumed in DIC (low), whereas it’s normal/high in liver failure.

1. Manage the cause (antibiotics and source control, obstetric management, treat APL with ATRA).
2. Transfuse platelets/FFP/cryoprecipitate for active bleeding or procedures.
3. Consider heparin if thrombotic manifestations dominate and bleeding is minimal.

• Think D‑dimer for DIC—almost always elevated.
• Oozing from IV sites in a septic or obstetric patient is classic.

• Rapid fall in fibrinogen with bleeding—give cryoprecipitate urgently.
• Unrecognized APL can present as fulminant DIC—look for promyelocytes; start ATRA promptly.

1. Suspect DIC → order CBC, PT/PTT, fibrinogen, D‑dimer, smear.
2. If ↓platelets + ↑PT/↑PTT + ↓fibrinogen + ↑D‑dimer → DIC likely.
3. Treat underlying cause; provide blood products as needed; monitor labs frequently.

• Postpartum patient with heavy bleeding, hypotension, schistocytes, ↓fibrinogen, ↑D‑dimer → DIC from placental abruption.
• Febrile patient with meningococcemia and diffuse purpura → DIC due to endotoxin‑driven tissue factor release.