Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (ko-ag-u-LA-shun), or DIC, is a condition in which blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body's organs.

In DIC, the increased clotting uses up platelets (PLATE-lets) and clotting factors in the blood. Platelets are blood cell fragments that stick together to seal small cuts and breaks on blood vessel walls and stop bleeding. Clotting factors are proteins needed for normal blood clotting.

With fewer platelets and clotting factors in the blood, serious bleeding can occur. DIC can cause internal and external bleeding.

Internal bleeding occurs inside the body. External bleeding occurs underneath or from the skin or mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)

DIC can cause life-threatening bleeding.

Overview

To understand DIC, it helps to understand the body's normal blood clotting process. Your body has a system to control bleeding. When small cuts or breaks occur on blood vessel walls, your body activates clotting factors. These clotting factors, such as thrombin and fibrin, work with platelets to form blood clots.

Blood clots seal the small cuts or breaks on the blood vessel walls. After bleeding stops and the vessels heal, your body breaks down and removes the clots.

Some diseases and conditions can cause clotting factors to become overactive, leading to DIC. These diseases and conditions include:

• Sepsis (an infection in the bloodstream)
• Surgery and trauma
• Cancer
• Serious complications of pregnancy and childbirth

Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.

The two types of DIC are acute and chronic. Acute DIC develops quickly (over hours or days) and must be treated right away. The condition begins with excessive blood clotting in the small blood vessels and quickly leads to serious bleeding.

Chronic DIC develops slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC. Chronic DIC causes excessive blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.

Treatment for DIC involves treating the clotting and bleeding problems and the underlying cause of the condition.

People who have acute DIC may need blood transfusions, medicines, and other life-saving measures. People who have chronic DIC may need medicines to help prevent blood clots from forming in their small blood vessels.

Outlook

The outlook for DIC depends on its severity and underlying cause. Acute DIC can damage the body's organs and even cause death if it's not treated right away. Chronic DIC also can damage the body's organs.

Researchers are looking for ways to prevent DIC or diagnose it early. They're also studying the use of various clotting proteins and medicines to treat the condition.

• Consumption coagulopathy
• Defibrination syndrome

Some diseases and conditions can disrupt the body's normal blood clotting process and lead to disseminated intravascular coagulation (DIC). These diseases and conditions include:

• Sepsis (an infection in the bloodstream)
• Surgery and trauma
• Cancer
• Serious complications of pregnancy and childbirth

Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.

The two types of DIC are acute and chronic. Acute DIC begins with clotting in the small blood vessels and quickly leads to serious bleeding. Chronic DIC causes blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.

Similar Clotting Conditions

Two other conditions cause blood clotting in the small blood vessels. However, their causes and treatments differ from those of DIC.

These conditions are thrombotic thrombocytopenic purpura (throm-BOT-ik throm-bo-cy-toe-PEE-nick PURR-purr-ah), or TTP, and hemolytic-uremic syndrome (HUS). HUS is more common in children than adults. It's also more likely to cause kidney damage than TTP.

Disseminated intravascular coagulation (DIC) is the result of an underlying disease or condition. People who have one or more of the following conditions are most likely to develop DIC:

• Sepsis (an infection in the bloodstream)
• Surgery and trauma
• Cancer
• Serious complications of pregnancy and childbirth

People who are bitten by poisonous snakes (such as rattlesnakes and other vipers), or those who have frostbite or burns, also are at risk for DIC.

Signs and symptoms of disseminated intravascular coagulation (DIC) depend on its cause and whether the condition is acute or chronic.

Acute DIC develops quickly (over hours or days) and is very serious. Chronic DIC develops more slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC.

With acute DIC, blood clotting in the blood vessels usually occurs first, followed by bleeding. However, bleeding may be the first obvious sign. Serious bleeding can occur very quickly after developing acute DIC. Thus, emergency treatment in a hospital is needed.

Blood clotting also occurs with chronic DIC, but it usually doesn't lead to bleeding. Sometimes chronic DIC has no signs or symptoms.

Signs and Symptoms of Excessive Blood Clotting

In DIC, blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels. This can cause the following signs and symptoms:

• Chest pain and shortness of breath if blood clots form in the blood vessels in your lungs and heart.
• Pain, redness, warmth, and swelling in the lower leg if blood clots form in the deep veins of your leg.
• Headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking and understanding if blood clots form in the blood vessels in your brain. These signs and symptoms may indicate a stroke.
• Heart attack and lung and kidney problems if blood clots lodge in your heart, lungs, or kidneys. These organs may even begin to fail.

Signs and Symptoms of Bleeding

In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal and external bleeding.

Internal Bleeding

Internal bleeding can occur in your body's organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:

• Blood in your urine from bleeding in your kidneys or bladder.
• Blood in your stools from bleeding in your intestines or stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.)
• Headaches, double vision, seizures, and other symptoms from bleeding in your brain.

External Bleeding

External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)

External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.

Purpura and Petechiae

The photograph shows purpura (bruises) and petechiae (red and purple dots) on the skin. Bleeding under the skin causes the purple, brown, and red color of the purpura and petechiae.

Other signs of external bleeding include:

• Prolonged bleeding, even from minor cuts.
• Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from brushing your teeth.
• Heavy or extended menstrual bleeding in women.

Your doctor will diagnose disseminated intravascular coagulation (DIC) based on your medical history, a physical exam, and test results. Your doctor also will look for the cause of DIC.

Acute DIC requires emergency treatment. The condition can be life threatening if it's not treated right away. If you have signs or symptoms of severe bleeding or blood clots, call 9–1–1 right away.

Medical History and Physical Exam

Your doctor will ask whether you have or have had any diseases or conditions that can trigger DIC. For more information about these diseases and conditions, go to "What Causes Disseminated Intravascular Coagulation?"

Your doctor will ask about signs and symptoms of blood clots and bleeding. He or she also will do a physical exam to look for signs and symptoms of blood clots and internal and external bleeding. For example, your doctor may look for bleeding from your gums.

Diagnostic Tests

To diagnose DIC, your doctor may recommend blood tests to look at your blood cells and the clotting process. For these tests, a small amount of blood is drawn from a blood vessel, usually in your arm.

Complete Blood Count and Blood Smear

A complete blood count (CBC) measures the number of red blood cells, white blood cells, and platelets in your blood.

Platelets are blood cell fragments that help with blood clotting. Abnormal platelet numbers may be a sign of a bleeding disorder (not enough clotting) or a thrombotic disorder (too much clotting).

A blood smear is a test that may reveal whether your red blood cells are damaged.

Tests for Clotting Factors and Clotting Time

The following tests examine the proteins active in the blood clotting process and how long it takes them to form a blood clot.

• PT and PTT tests. These tests measure how long it takes blood clots to form.
• Serum fibrinogen. Fibrinogen is a protein that helps the blood clot. This test measures how much fibrinogen is in your blood.
• Fibrin degradation. After blood clots dissolve, substances called fibrin degradation products are left behind in the blood. This test measures the amount of these substances in the blood.

Treatment for disseminated intravascular coagulation (DIC) depends on its severity and cause. The main goals of treating DIC are to control bleeding and clotting problems and treat the underlying cause.

Acute Disseminated Intravascular Coagulation

People who have acute DIC may have severe bleeding that requires emergency treatment in a hospital. Treatment may include blood transfusions, medicines, and oxygen therapy. (Oxygen is given through nasal prongs, a mask, or a breathing tube.)

A blood transfusion is a safe, common procedure. You receive blood through an intravenous (IV) line in one of your blood vessels. Blood transfusions are done to replace blood loss due to an injury, surgery, or illness.

Blood is made up of various parts, including red blood cells, white blood cells, platelets, and plasma. Some blood transfusions involve whole blood (blood with all of its parts). More often though, only some parts of blood are transfused.

If you have DIC, you may be given platelets and clotting factors, red blood cells, and plasma (the liquid part of blood).

Chronic Disseminated Intravascular Coagulation

People who have chronic DIC are more likely to have blood clotting problems than bleeding. If you have chronic DIC, your doctor may treat you with medicines called anticoagulants, or blood thinners.

Blood thinners help prevent blood clots from forming. They also keep existing blood clots from getting larger.

If you have disseminated intravascular coagulation (DIC), ask your doctor how often you should schedule followup care and blood tests. Blood tests help track how well your blood is clotting.

You may need to take blood-thinning medicines (blood thinners) to help prevent blood clots or to keep existing clots from getting larger. If you take blood thinners, let everyone on your health care team know.

Blood thinners may thin your blood too much and cause bleeding. A lot of bleeding after a fall or injury or easy bruising or bleeding may mean that your blood is too thin.

Call your doctor right away if you have any signs of bleeding. If you have severe bleeding, call 9–1–1 right away.

Also, you should talk with your doctor before using any over-the-counter medicines or products, such as vitamins, supplements, or herbal remedies. Some of these products also can affect blood clotting and bleeding. For example, aspirin and ibuprofen may thin your blood too much. This can increase your risk of bleeding.

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 for dental work, but it's less common.