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.

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.

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

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

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

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 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

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

• 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.

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.

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.

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

• Return to Risk Factors to review how infection, injury, lifestyle, or other medical conditions may increase your risk of developing DIC.
• Return to Signs, Symptoms, and Complications to review common signs and symptoms of DIC.

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.

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.

• 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.

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.

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.

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.

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.