see also: [[Haemolytic uraemic syndrome|HUS]], [[Thrombotic Thrombocytopaenic purpura|TTP]] > **definition:** systemic pathological process that results in both thrombosis and haemorrhage initiated by a number of defined disorders massive activation of clotting system → generalised activation of fibrinolytic system ![[12328D07-4D7E-4876-86BE-C0676AF0C7FF.jpeg]] # causes - Tissue damage (eg trauma, major surgery) - [[Burns]] - infection - shock states in general - malignancy - [[Pre-eclampsia|Eclampsia]] - [[placental abruption]] - [[Snakebite]] - severe pancreatitis - [[amniotic fluid embolism]] most common ED causes: - sepsis - massive blood loss - major head injury - snake bite - eclampsia - [[rhabdomyolysis]] - [[Heat-related illness|Heat Stroke]] > **mnemonic**:: HOTMISS > - hepatic failure > - obstetric > - amniotic fluid embolism > - eclampsia > - fetal death in utero > - trauma > - malignancy > - prostate, mucinous, APML > - immune > - [[Acute transfusion reactions]] > - [[Anaphylaxis]] > - [[Sepsis]] > - gram negative > - viral haemorrhagic fevers (eg [[Malaria]] > - shock of other causes # clinical features 1. suffering from a recognised cause of DIC 2. evidence of MODS: 1. multi-site bleeding 2. renal failure 3. hypotension 4. [[ARDS]] 5. ALOC 3. Lab evidence # Lab investigations ![[Pasted image 20240219141140.png]] ^ from [rosen DIC](x-devonthink-item://F3C647AF-B411-4C79-AA85-8C42F04A7DFC?page=12&istart=1007&ilength=37&search=Disseminated%20Intravascular%20Coagulation) > [!treatment] Ix > - decreased fibrinogen levels > - increased fibrin degredation products (↑ [[D-dimer]]) > - generally > 30 > - <2 unlikely to be DIC > - increased thrombin time (reflects ongoing fibrinolysis) > - low platelet levels > - ↑ INR > - ↑ APTT > - decreased protein C ## DIC scoring system | item | 0 | 1 point | 2 point | 3 points | | ---------------- | ------ | ------- | ------------ | -------------- | | plt count | >100 | 50-100k | <50k | - | | d dimer | normal | | mod increase | large increase | | prothrombin time | <3 s | 3-6s | ≥ 6s | | | fibrinogen | ≥ 1 | <1 | | | - ≥ 5 : suggests overt DIC - <5 : suggests non-overt DIC # Differences from TTP and HUS - patients with TTP-HUS present with thrombocytopaenia and microangiopathic blood smere, but usually have normal levels of coagulation components and *little or no prolongation of PT or APTT* . the *fibrinogen levels* and D-dimer levels in TTP-HUS are also *normal*. - TTP-HUS is initially treated with **plasma exchange**, but this is **NOT** the modality used to treat DIC # Management - supportive - treat underlying cause - +/- blood components - fibrinogen <50 mg/dL need [[FFP]] or [[cryoprecipitate]] target fibrinogen >100mg/dL - tx pts at high risk of bleeding - [[thrombocytopaenia]] <50,000 mc/L need platelet transfusion