OVERVIEW

What is Disseminated Intravascular Coagulation?

Disseminated Intravascular Coagulation (DIC) refers to a pathophysiological process triggered by certain pathogenic factors, characterized by the widespread formation of microthrombi (invisible to the naked eye and detectable only under a microscope) in microvessels. This leads to massive consumption of clotting factors and platelets, followed by enhanced secondary fibrinolytic activity, resulting in systemic bleeding and coagulation dysfunction.

The main clinical manifestations of DIC include hemorrhage, shock, organ dysfunction, anemia, etc., making it a critical syndrome.

DIC is a relatively common clinical syndrome rather than a specific disease, as it can be caused by various underlying conditions.

Is Disseminated Intravascular Coagulation High-Risk?

DIC is a highly life-threatening clinical syndrome. Even with aggressive treatment, most patients may succumb to hemorrhage or multiple organ failure. Survivors often face sequelae such as renal insufficiency or sensory/motor impairments.

SYMPTOMS

What are the symptoms of disseminated intravascular coagulation?

• Bleeding tendency: Characterized by spontaneous and multiple bleeding, which can occur throughout the body, commonly seen in the skin, mucous membranes, and wounds. There may also be spontaneous bleeding in vital organs, including gastrointestinal bleeding, urinary tract bleeding, and intracranial bleeding.
• Shock or microcirculatory failure: Symptoms include decreased blood pressure, cold and clammy limbs, cyanosis of the lips, altered mental status, and organ dysfunction or even multiple organ failure in the kidneys, lungs, liver, and brain.
• Microvascular thrombosis: Pale and ischemic skin and gastrointestinal mucosa, with a few patients developing localized necrosis or ulcers.
• Microangiopathic hemolytic anemia: Progressive anemia accompanied by jaundice in the skin and sclera.
• Symptoms of the underlying disease: Such as severe infection or poisoning.

What is the progression of disseminated intravascular coagulation?

The progression of disseminated intravascular coagulation can be divided into three stages:

• Hypercoagulable stage: Various diseases lead to excessive activation of the coagulation system, resulting in the formation of numerous microthrombi in the microvasculature.
• Consumptive hypocoagulable stage: During the formation of extensive microthrombi, coagulation factors and platelets are heavily consumed. Concurrently, the fibrinolytic system may be activated as a feedback mechanism, leading to a consumptive hypocoagulable state. Patients may exhibit bleeding symptoms during this stage.
• Secondary hyperfibrinolysis stage: The fibrinolytic system becomes further overactivated, resulting in more pronounced bleeding and progressive worsening of organ ischemia and hypoxia until organ failure occurs.

CAUSES

What conditions can trigger disseminated intravascular coagulation?

• Infectious diseases: Bacterial infections such as pneumonia and sepsis; viral infections like viral hepatitis and epidemic hemorrhagic fever.
• Neoplastic diseases: Advanced stages of various malignant tumors, where most patients may exhibit hypercoagulability (hypercoagulable state).
• Obstetric and gynecological diseases: Amniotic fluid embolism, eclampsia and preeclampsia, placental abruption, uterine rupture, etc.
• Toxicity and immune reactions: Snake bites, transfusion reactions, transplant rejection, etc.
• Trauma and surgery: Severe trauma, extensive burns, various surgical procedures.

How is disseminated intravascular coagulation classified?

Based on progression speed, it is generally divided into three types.

• Acute type: Rapid progression within hours to 1–2 days, the most common clinical type. Often seen in severe infectious diseases, major trauma, post-surgery, etc.
• Subacute type: Develops into disseminated intravascular coagulation within several days (≥ 3 days) after disease onset. Common causes include advanced malignancies, intrauterine fetal death, etc.
• Chronic type: Prolonged course with milder symptoms, lasting from tens of days to months, primarily manifesting as progressive organ dysfunction, and may transition to the acute type. Frequently observed in advanced malignancies, connective tissue diseases, etc.

DIAGNOSIS

How is disseminated intravascular coagulation diagnosed?

The diagnostic criteria include three aspects:

• Presence of underlying conditions, surgical history, or trauma history that may predispose to DIC.
• Two or more of the following clinical manifestations:
  • Multiple bleeding tendencies;
  • Shock or microcirculatory failure symptoms not easily explained by the primary disease;
  • Multiple microvascular thrombosis symptoms, such as skin or mucosal necrosis and rapidly progressing organ failure (e.g., lung, kidney, brain);
  • Improvement with anticoagulant therapy.
• Laboratory tests: platelet count, coagulation function, fibrinogen, D-Dimer, etc.

TREATMENT

Can disseminated intravascular coagulation be cured?

The mortality rate of DIC patients remains high. Although treatment success rates have improved with deeper understanding of its pathophysiology and advances in critical care medicine, the overall prognosis remains poor.

How is disseminated intravascular coagulation treated?

In brief, treatment includes:

• Removing the cause: Anti-infection measures, treating tumors and trauma, etc.;
• Anticoagulation therapy: Reducing organ damage, reestablishing coagulation-anticoagulation balance, etc.;
• Replacement therapy: Correcting anemia, supplementing clotting factors, etc.;
• Other supportive treatments: Nutritional support, maintaining water-electrolyte balance, etc.

Will disseminated intravascular coagulation leave sequelae?

If DIC leads to organ failure, even with successful rescue, sequelae such as kidney or brain dysfunction may still remain.

DIET & LIFESTYLE

What aspects of health education should be provided to patients with disseminated intravascular coagulation?

• Explain DIC-related knowledge to patients to help them and their families build confidence in overcoming the disease.
• Guide patients on proper diet, rest, and gradually increasing physical activity.

PREVENTION

Can disseminated intravascular coagulation be prevented?

For patients with severe infections, major trauma, or extensive surgical injuries, timely and effective infection control, treatment of the underlying disease, and active symptomatic treatment can help prevent DIC.

However, due to the "black box" nature of the human body, DIC can sometimes be unpredictable. For example, some patients rapidly progress to DIC even when their infection or trauma is not particularly severe, with severe cases even leading to death.