Disseminated intravascular coagulation (DIC)
Disseminated intravascular coagulation is an acquired disorder, characterized by generalized and poorly controlled coagulation in the peripheral circulation with subsequent consumption coagulopathy. Due to its non-specific manifestations and often a fulminant course, it is considered a serious life-threatening condition with high mortality. In this algorithm, we look at some of the manifestations of this disorder and focus on the diagnosis and therapeutic interventions. Last but not least, we will introduce the use of viscoelastic methods in the diagnostics and optimization of transfusion and hemostatic therapy.
Review
Disseminated intravascular coagulation (DIC) is a very insidious acquired syndrome, which is manifested by a complex breakdown of blood coagulation, with depletion of coagulation factors and platelets and subsequent thrombotization in various parts of the capillary bed. One of the intricacies of this syndrome is its slow-onset clinical and laboratory manifestations, which can escape our attention for a long time, and thus we can only notice DIC in the phase of massively accelerating manifestations, which dramatically worsen the condition of our patients, and the therapeutic intervention is no longer easy nor cheap. In general, it can be paraphrased that standing in front of a rolling avalanche always costs us dearly.
The goal of the interactive algorithm is to familiarize us with the clinical and laboratory manifestations of DIC on a casuistic model and to introduce the types of diseases that can cause this syndrome.
Sources
ZADÁK, Zdeněk a Eduard HAVEL. Intenzivní medicína na principech vnitřního lékařství. 2., doplněné a přepracované vydání. Praha: Grada Publishing, 2017. ISBN 978-80-271-0282-2.
ŠEVČÍK, Pavel a Martin MATĚJOVIČ, ed. Intenzivní medicína. 3., přeprac. a rozš. vyd. Praha: Galén, c2014. ISBN 978-80-7492-066-0.
FARKAS, J. (2021, November 29). Acute disseminated intravascular coagulation (DIC). EMCrit Project. Avaialble at: https://emcrit.org/ibcc/dic/
CROCHEMORE, Tomaz, Flavia NUNES DIAS CAMPOS, Camila MENEZES SOUZA PESSOA, Leonardo LIMA ROCHA, Pedro Paulo ZANELLA DO AMARAL CAMPOS a Thiago Domingos CORRÊA. Thromboelastometry-guided blood transfusion in septic shock complicated with disseminated intravascular coagulation: a case report. Clinical Case Reports [online]. 2017, 5(5), 701-706. ISSN 20500904. Available at: doi:10.1002/ccr3.912
Multimedia created in Biorender.com based on Osmosis.org: Disseminated Intravascular coagulation. Available at: https://www.osmosis.org/learn/Disseminated_intravascular_coagulation
Learning targets
2. Student is aware of the indications as well as the risks tied to blood replacement therapy
3. Student recognizes the risk factors leading to the development of DIC
4. Student understands the coagulation cascade and common therapeutic interventions
Key points
2. The International Society for Thrombosis and Hemostasis (ISTH) scoring system provides an objective assessment of whether observed coagulopathies are consistent with DIC
3. The basis of DIC therapy is early detection and elimination of the underlying cause
4. The most common causes of DIC are generalized infections, trauma, malignancies and serious obstetric complications.
