Disseminated Intravascular Coagulation

Also known as Consumption Coagulopathy
Disseminated intravascular coagulation (DIC) is a rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels. It is caused by another disease or condition, such as an infection or injury, that makes the body’s normal blood clotting process become overactive.

DIC may develop quickly over hours or days, or more slowly. Signs and symptoms may include bleeding, bruising, low blood pressure, shortness of breath, or confusion. Complications can be life-threatening and include bleeding or multiple organ failure.

DIC that develops quickly usually requires emergency treatment in the hospital. In treating DIC, your doctor will treat the disease that is causing DIC. Your doctor may also give you medicines to prevent blood clots, or blood products such as platelets or clotting factors to stop bleeding.

Explore this Health Topic to learn more about DIC, our role in research and clinical trials to improve health, and where to find more information.

Causes - Disseminated Intravascular Coagulation

DIC is caused by another medical condition that makes the body’s normal blood clotting process become overactive. The condition progresses through two stages. In the early stages, overactive clotting leads to blood clots throughout the blood vessels. The clots can reduce or block blood flow, damaging organs.

As DIC progresses, the overactive clotting uses up platelets and clotting factors, which are proteins that help with normal blood clotting. Without these platelets and clotting factors, DIC can cause bleeding just beneath the skin, in the nose or mouth, or deep inside the body.

Causes of DIC include:

  • Inflammation in response to infection, injury, or an illness
  • Severe tissue damage, such as from burns or trauma
  • Clotting factors caused by some cancers or pregnancy complications. Pregnancy complications that produce clotting factors include placental abruption, in which the placenta separates from the uterus, and amniotic fluid embolism, in which amniotic fluid that surrounds the unborn baby enters the mother’s bloodstream.

To understand DIC, it helps to understand the body’s normal blood clotting process. Learn more about how blood clots form.

Look for
- Disseminated Intravascular Coagulation

  • Risk Factors will discuss the conditions that increase your risk of DIC.
  • Treatment will discuss treatments that your doctors may recommend if you are diagnosed with DIC.

Risk Factors - Disseminated Intravascular Coagulation

Risk factors for DIC include infection, injury, lifestyle habits, and other medical conditions.

Infection
- Disseminated Intravascular Coagulation

Sepsis, a body-wide response to infection that causes inflammation, is the most common risk factor for DIC. The infection may be caused by parasites, bacteria, fungi, or viruses.

Injury
- Disseminated Intravascular Coagulation

Major damage to organs or tissues can raise your risk of DIC. Examples include cirrhosis, pancreatitis, severe trauma or injury, burns, or major surgery.

Lifestyle habits
- Disseminated Intravascular Coagulation

Use of illegal drugs, such as cocaine and ecstasy, may increase the risk of DIC.

Other medical conditions
- Disseminated Intravascular Coagulation

Medical conditions that may raise your risk of DIC include:

  • Blood vessel abnormalities, including aortic aneurysms and large hemangiomas, which are growths of tangled blood vessels
  • Cancer, including cancers affecting the pancreas, stomach, colon, or blood
  • Heat stroke
  • Pregnancy complications, such as when the placenta separates from the uterus before delivery, when amniotic fluid enters the bloodstream, or when there is serious bleeding during or after delivery
  • Severe immune reactions, which may occur with an incompatible blood transfusion, rejection of an organ transplant, or a toxin such as snake venom

Screening and Prevention - Disseminated Intravascular Coagulation

Routine screening is not performed for DIC. If you have a medical condition that raises your risk for DIC, your doctor may recommend testing. For more information about medical tests, visit the Diagnosis section.

Prevention
- Disseminated Intravascular Coagulation

DIC can result from many medical conditions, most of which cannot be prevented. Sometimes, immediate or prompt treatment after a procedure or medical condition may help prevent DIC.

Signs, Symptoms, and Complications - Disseminated Intravascular Coagulation

Signs and symptoms of DIC depend on whether the condition is acute or chronic. Acute DIC is more severe and develops quickly over hours or days. The first sign may be bleeding. Chronic DIC, such as from cancer, happens more slowly and sometimes has no signs or symptoms.

Complications from DIC can occur from both the clotting that happens in the early stages of the condition and from bleeding in the later stages. Serious complications include organ damage and hemorrhage.

Signs and symptoms
- Disseminated Intravascular Coagulation

Signs and symptoms of DIC may include:

  • Bruising, which may appear easily, and often in various areas as small dots or larger patches
  • Bleeding at the site of wounds from surgical cuts or from placement of a needle
  • Bleeding from the nose, gums, or mouth, including when you brush your teeth
  • Blood in the stools from bleeding in the intestines or stomach. Stools may appear dark red or like tar.
  • Blood in the urine
  • Chest pain, trouble breathing, and shortness of breath
  • Confusion, speech changes or trouble speaking, dizziness, or seizures
  • Headaches
  • Low blood pressure
  • Pain, redness, warmth, and swelling in the lower leg
  • Unusually heavy periods
Purpura and petechiae in the skin
Purpura and petechiae in the skin. The photograph shows two types of bruising that are often seen with DIC. The larger red, brown, and purple dots are purpura and the smaller red and purple dots are petechiae. 

 

Complications
- Disseminated Intravascular Coagulation

DIC can lead to complications resulting from overactive clotting or from the bleeding that follows. These complications can be life-threatening and may include:

  • Acute respiratory distress syndrome (ARDS)
  • Bleeding from the gastrointestinal tract (GI tract) or elsewhere in the body if you have acute DIC. This is not common in chronic DIC, since clotting develops more slowly, and your body can make enough platelets and clotting factors.
  • Heart attack, if a blood clot blocks or limits blood flow to your heart
  • Multiple organ failure, if blood clots prevent oxygen from reaching your organs. These organs can include the lungs and kidneys, followed by the brain, heart, liver, spleen, adrenal glands, pancreas, and the GI tract.
  • Shock
  • Stroke, if a blood clot blocks or limits blood flow to your brain, or if there is bleeding in the brain
  • Venous thromboembolism (VTE), which can include blood clots in the lungs, called pulmonary embolism, or in the deep veins of the legs, called deep vein thrombosis

Look for
- Disseminated Intravascular Coagulation

  • Diagnosis will explain tests and procedures used to detect signs of DIC and help rule our other conditions that may mimic DIC.
  • Treatment will discuss treatment-related complications or side effects.

Diagnosis - Disseminated Intravascular Coagulation

Your doctor will diagnose DIC based on your medical history, a physical exam, and tests. Your doctor will also look for the cause of DIC, because it does not occur on its own.

Medical history and physical exam
- Disseminated Intravascular Coagulation

To help diagnose DIC, your doctor will ask about any medical conditions or recent events, such as illness or an injury, that could cause or be a risk factor for DIC. Your doctor will do a physical exam to look for signs and symptoms of blood clots, bleeding, or a condition that could cause DIC or a complication of DIC.

Diagnostic tests
- Disseminated Intravascular Coagulation

If your doctor suspects DIC, the following blood tests may help diagnose it:

  • Blood clotting tests, such as prothrombin time (PT) and partial thromboplastin time (PTT), to measure how well and how long it takes your blood to clot. If you have DIC, your clotting time may be longer than normal.
  • Complete blood count (CBC) to measure the number of red blood cells, white blood cells, and platelets in your blood. If you have DIC, the numbers of platelets, red cells, or both may be low.
  • Comprehensive metabolic panel (CMP) to measure your kidney function, liver function, and the sugar and electrolyte levels in your blood. Abnormal results could indicate that DIC caused damage to your kidneys or liver or could identify another underlying condition that caused your DIC.
  • D-dimer tests to look for blood clots. The test measures D-dimer, a substance that is released in the blood when blood clots dissolve. D-dimer levels may be high if you have DIC.
  • Peripheral blood smear to look at the number, size, and shape of your platelets and other blood cells. In a peripheral blood smear, a small amount of your blood is examined under a microscope. The presence of damaged red blood cells may suggest DIC.
  • Serum fibrinogen tests to measure how much fibrinogen is in your blood. Fibrinogen is a protein that helps the blood clot and may be low if you have DIC.

Your doctor may use a scoring system to diagnose DIC. The score is based on your platelet count, PT, D-dimer test, and fibrinogen levels. The higher the score, the more likely it is that you have DIC. To make a diagnosis, your doctor may repeat some tests and monitor your condition over time.

Tests for other medical conditions
- Disseminated Intravascular Coagulation

Your doctor may suggest additional tests or procedures to find out whether another condition is causing your symptoms. These tests may include:

  • ADAMTS13 testing to check blood levels and activity of this protein, which is low in thrombotic thrombocytopenic purpura (TTP), a type of platelet disorder
  • Liver biopsy and liver function tests to check for cirrhosis or chronic liver disease, which may have signs and symptoms that are similar to DIC

Reminders
- Disseminated Intravascular Coagulation

Treatment - Disseminated Intravascular Coagulation

Treatment for DIC depends on its severity and symptoms. The main goals of treatment for DIC are to control clotting and bleeding and to treat the underlying cause. DIC may go away once the underlying cause is treated.

Medicines
- Disseminated Intravascular Coagulation

Your doctor may use anticoagulants, also called blood thinners, to reduce blood clotting. You may be given them as a pill, as an injection, or through an IV. Possible side effects include bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.

Procedures and therapies
- Disseminated Intravascular Coagulation

Your doctor may recommend the following treatments.

  • Clotting factor replacement such as fibrinogen. This is used to stop bleeding.
  • Oxygen therapy to allow more oxygen to reach the lungs, the heart, and the rest of the body if blood clots are preventing oxygen from reaching your organs.
  • Plasma transfusion, which provides clotting factors, to stop or prevent bleeding.
  • Platelet transfusion to quickly raise platelet levels to stop or prevent bleeding.

Look for
- Disseminated Intravascular Coagulation

  • Research for Your Health will discuss how we are using current research and advancing research to treat people who have DIC.
  • Participate in NHLBI Clinical Trials will explain our open and enrolling clinical studies that are investigating treatments for DIC.
  • Living With will discuss what your doctor may recommend, including lifelong lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications.

Living With - Disseminated Intravascular Coagulation

Acute DIC and its underlying causes are serious life-threatening conditions, so your treatment management and recovery will likely be done in the hospital. If you have been diagnosed with DIC, it is important that you follow your treatment plan, get regular care, and learn the warning signs of complications.

Receive routine follow-up care
- Disseminated Intravascular Coagulation

Your follow-up care may include recommendations such as the following.

  • Take all medicines regularly, as your doctor prescribes. Do not change the amount of your medicine or skip a dose unless your doctor tells you to.
  • Follow all treatments and testing for the medical condition that caused your DIC.
  • Talk with your doctor about how often you should schedule office visits and blood tests.
  • Call your doctor if you have any new symptoms or if your symptoms worsen.

Return to Treatment to review possible treatment options for your DIC.

Monitor your condition and prevent complications
- Disseminated Intravascular Coagulation

You may need to take blood-thinning medicines to help prevent blood clots or to keep existing clots from getting larger. If you are taking blood thinners, talk to your doctor about how often you should schedule follow-up visits. Your doctor may recommend regular blood tests to check how well your blood is clotting.

Also, let everyone on your healthcare team know you are taking blood-thinning medicines. If you need surgery, your doctor may adjust the amount of medicine you take before, during, and after the surgery to prevent bleeding. This also may happen before dental work, but it is less common.

Learn the warning signs of serious complications and have a plan
- Disseminated Intravascular Coagulation

DIC can lead to serious complications such as heart attack or stroke. Risks of treatment with blood thinners include severe bleeding in the brain.

If you think that you or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.

Bleeding

If you take a dose of blood-thinning medicine that is too high, it may cause bleeding in the digestive system or in the brain. Signs and symptoms include severe pain in your head, sudden changes in your vision, sudden inability to move your legs or arms, memory loss or confusion, bright red vomit or vomit that looks like coffee grounds, blood in your urine or stool, or black, tarry stools.

A lot of bleeding after a fall or injury, or easy bruising or bleeding, may mean that your blood is too thin. Excessive bleeding is bleeding that will not stop after you apply pressure to a wound for 10 minutes. Call your doctor right away if you have any of these signs.

Heart attack

Heart attack symptoms include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. This discomfort can feel like pressure, squeezing, fullness, heartburn, or indigestion. There also may be pain down the left arm. Although men and women can experience these symptoms, women are more likely to have other, less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.

Stroke

If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.

Read more about the signs and symptoms of a stroke.

Learn about other precautions to help you stay safe
- Disseminated Intravascular Coagulation

Talk with your doctor before using any over-the-counter medicines or products, including vitamins, supplements, or herbal remedies. Some of these products can affect blood clotting and bleeding. For example, aspirin and ibuprofen may thin your blood too much. This can increase your risk of bleeding. Vitamin K supplements can prevent certain blood thinners from working.

Research for Your Health

The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including DIC. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.

Improving health with current research
- Disseminated Intravascular Coagulation

Learn about the following ways the NHLBI continues to translate current research into improved health for people who have DIC. Research on this topic is part of the NHLBI’s broader commitment to advancing blood disorders and blood safety scientific discovery.

  • Helping understand the biology of DIC. NHLBI-supported studies laid the groundwork for understanding DIC, which was critical for later studies on treatments for the condition. For example, studies in the 1980s determined that the clotting factor protein C, which prevents clots, is activated in DIC and plays a major role in controlling the disease. Having low levels of protein C, such as from gene mutations, makes people more likely to develop DIC if they have a bacterial infection; it also is linked to poor health outcomes.
  • Studying underlying factors in severe trauma cases. The Trans-Agency Research Consortium for Trauma-Induced Coagulopathy (TACTIC) research program was a partnership between the NHLBI and the Department of Defense to study the disruptions in the normal process of blood clotting that occur in people who experience severe trauma.
  • Accelerating translation of discoveries into innovative approaches. The Vascular Interventions/Innovations and Therapeutic Advances (VITA) Program is a translational program that supports and accelerates early-stage development of promising diagnostics and treatments. The VITA Program seeks to address unmet clinical needs for vascular diseases, particularly in underserved medical communities.
  • The NHLBI Research Workshop on Implementation Science in Critical Care. The NHLBI convened a workshop in 2016 to discuss opportunities and needs for implementation science research in critical care. The workshop covered critical illnesses including sepsis, a leading cause of DIC. Learn more about the workshop on implementation research in critical care.

Advancing research for improved health
- Disseminated Intravascular Coagulation

In support of our mission, we are committed to advancing research into vascular diseases and clotting disorders, including disseminated intravascular coagulation, in part through the following ways:

Learn about exciting research areas the NHLBI is exploring about DIC.

Participate in NHLBI Clinical Trials

We lead or sponsor many studies aimed at preventing, diagnosing, and treating heart, lung, blood, and sleep disorders. See if you or someone you know is eligible to participate in our clinical trials.

More Information

After reading our Disseminated Intravascular Coagulation Health Topic, you may be interested in additional information found in the following resources.

Non-NHLBI resources
- Disseminated Intravascular Coagulation

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