What is disseminated intravascular coagulation (DIC)?
Disseminated intravascular coagulation (DIC) is a rare, life-threatening
condition that prevents a person's blood from clotting normally. It may cause
excessive clotting (thrombosis) or bleeding (hemorrhage) throughout the body
and lead to
shock, organ failure, and death.
the body's natural ability to regulate blood clotting does not function
properly. This causes the blood's clotting cells (platelets) to
clump together and clog small blood vessels throughout the body. This excessive
clotting damages organs, destroys blood cells, and depletes the supply of
platelets and other clotting factors so that the blood is no longer able to
clot normally. This often causes widespread bleeding, both internally and
What causes DIC?
DIC can be triggered by a health
problem that sets the clotting cascade in motion. Such health problems include:
especially from brain injuries, crushing injuries, burns, and extremely low
body temperature (hypothermia).
Complications during pregnancy.
Some types of
In most cases, the condition causing the DIC will be
known (such as severe trauma). In rare cases, extensive bleeding caused by DIC
will be the first symptom of the disease or condition causing it (such as
What are the symptoms?
When DIC causes the blood's
platelets and clotting factors to become depleted, excessive bleeding
(hemorrhage) occurs throughout the body. The severity of bleeding can range
from small red dots and bruises under the skin to heavy bleeding from surgical
wounds or body openings, such as the mouth, nose, rectum, or vagina.
Symptoms of organ damage caused by excessive blood clotting may include
shortness of breath from lung damage, low urine output from kidney damage, or
stroke from damage to the brain. In severe cases,
shock, with low blood pressure and widespread organ failure, may occur.
In a less severe type of DIC called chronic DIC, the body is able to
compensate for the abnormal clotting. Chronic DIC may produce no symptoms or
only mild blood clotting or minimal bleeding from the skin or mouth.
How is DIC diagnosed?
DIC is a very complex
condition that can be hard to diagnose. There is no single test that is used to
diagnose DIC. In some cases, several different tests given over a period of
time may be needed for an accurate diagnosis.
A doctor may suspect
DIC in a person who has symptoms of excessive bleeding or clotting. Blood tests
to measure the amount of platelets and other substances (such as prothrombin
and fibrinogen) that affect clotting can help confirm the diagnosis.
Tests that may be used to diagnose DIC include:
This blood test helps determine whether a person's blood is clotting normally
by measuring a substance (fibrin) that is released as a blood clot breaks up.
D-dimer levels are often higher than normal in people who have abnormal blood
Prothrombin time (PT/INR). This blood test measures how
long it takes blood to clot. At least a dozen blood proteins, or clotting
factors, are needed to clot blood and stop bleeding (coagulation). Prothrombin,
or factor II, is one of several clotting factors produced by the liver. A long
prothrombin time can be a sign of DIC.
Fibrinogen. This blood test
measures how much fibrinogen is in the blood. Fibrinogen is a protein that
plays a part in blood clotting. A low fibrinogen level can be a sign of DIC. It
happens when the body is using fibrinogen faster than the body can make it.
Complete blood count (CBC). A complete blood count
(CBC) involves taking a blood sample and counting the number of red blood cells
and white blood cells. CBC results cannot diagnose DIC, but they provide
information to help the doctor make a diagnosis. (DIC often causes the platelet
count to drop.)
Blood smear. In this test, a drop of blood is
smeared on a slide and stained with a special dye. The slide is then examined
under a microscope. The number, size, and shape of red blood cells, white blood
cells, and platelets are recorded. Blood cells often look damaged and abnormal
in people who have DIC.
How is it treated?
DIC depends on the medical condition that is causing
it. If that condition can be treated, the DIC may get better. People with acute
DIC require hospitalization, sometimes in an intensive care unit (ICU), where
treatment will attempt to correct the problem causing the DIC while maintaining
the function of the organs.
blood cells and other blood products may be needed to replace blood that has
been lost through bleeding and to replace clotting factors used up by the
In some cases a blood thinner, such as heparin, is used. This
shuts down the cascade of events that make the body overuse its blood clotting
Other Places To Get Help
National Heart, Lung, and Blood Institute
P.O. Box 30105
Bethesda, MD 20824-0105
The U.S. National Heart, Lung, and Blood Institute
(NHLBI) information center offers information and publications about preventing
Diseases affecting the heart and circulation, such as heart
attacks, high cholesterol, high blood pressure, peripheral artery disease, and
heart problems present at birth (congenital heart diseases).
Diseases that affect the lungs, such as asthma, chronic
obstructive pulmonary disease (COPD), emphysema, sleep apnea, and
Diseases that affect the blood, such as anemia,
hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.
Other Works Consulted
Halfdanarson TR, et al. (2012). Emergencies in hematology and oncology. In EG Nabel, ed., ACP Medicine, section 8, chap. 5. Hamilton, ON: BC Decker.
Levi M, Seligsohn U (2010). Disseminated intravascular coagulation. In K Kaushanksy et al., eds., Williams Hematology, 8th ed., pp. 2101–2120. New York: McGraw-Hill.
Santen SA, Hemphill RR (2011). Acquired bleeding disorders. In JE Tintinalli, ed., Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7th ed., pp. 1464–1470. New York: McGraw-Hill.
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