What Is Disseminated Intravascular Coagulation (DIC)? Its Causes and Symptoms

The English term “disseminated intravascular coagulation” (DIC) refers to a serious disease that causes problems with blood clotting and bleeding. Cancer or an abnormal response to infection by the immune system that causes organ dysfunction, known as sepsis, can be underlying health conditions that cause DIC.

DIC has two different stages:

• the first causes excessive clotting that can damage organs,
• while the second causes bleeding that is difficult to control; in other words, clotting first, then bleeding.

Treating the underlying condition is the foundation for achieving a positive outcome.

What Is Disseminated Intravascular Coagulation (DIC)?

DIC occurs when the body loses control over its blood-clotting system.

A blood clot normally helps stop bleeding after an injury. The body needs platelets and clotting factors to form clots. Platelets are a type of blood cell. Clotting factors are proteins that cause clots to form.

In the first stage of DIC, the proteins responsible for clotting become overactive throughout the body, causing many clots to develop spontaneously in blood vessels. These clots can block blood flow to vital organs, including the brain, liver and kidneys, damaging those organs.

In the second stage of DIC, the blood clots so much that platelets and clotting factors are depleted (we call this “consumption coagulopathy”). This causes uncontrolled bleeding that can occur just under the skin, in the nose or mouth, or inside the body.

What Are the Symptoms of DIC?

A person's symptoms vary depending on whether they are experiencing the first or second stage of DIC. However, general symptoms of DIC include:

• Bleeding from a wound
• Bleeding from the nose, mouth or gums
• Bleeding from the rectum or vagina
• Blood in the stool or urine
• Tiny spots or larger bruises on the skin
• Chest pain
• Pain, inflammation and swelling in a leg

People who experience any symptoms of a blood clot need urgent medical attention. For unexplained or uncontrollable bleeding, call 112 or seek medical help immediately.

Causes and Risk Factors for DIC

Severe inflammation caused by an infection, injury or disease can cause DIC. DIC always occurs as a result of another health condition and is most often seen in people hospitalized for a serious reason. It is therefore important for the doctor and healthcare team to recognize DIC and detect it early.

Sepsis is the most common cause of DIC. A person with sepsis has a body-wide response to an infection that causes inflammation. Approximately 35% of people with sepsis develop DIC.

Other causes of DIC may include:

• Major Organ Damage: This can result from liver cirrhosis, pancreatitis, a severe injury or burn, or major surgery.
• Excessive Immune Reaction: This may occur because of an incorrect blood transfusion, rejection of a transplanted organ or exposure to a toxin such as snake venom.
• Serious Pregnancy Complications: Amniotic fluid leaking into the bloodstream, major bleeding during or after delivery, or the placenta separating from the uterus during pregnancy are serious pregnancy complications that can also cause DIC.
• Very rarely, cancer can also cause DIC.

Table 1: Diseases associated with DIC and their possible outcomes are listed below:

How Is DIC Diagnosed?

To diagnose DIC, specialists review the person's medical history, perform a physical examination and order the necessary tests. There is no single test for diagnosing DIC.

In 2007, researchers developed a scoring system to help specialists diagnose DIC. This system considers the following:

• Platelet count
• Prothrombin time (PT), or the time it takes blood to clot
• Markers of fibrin, an important substance in forming blood clots
• Levels of fibrinogen, which the body converts into fibrin after an injury

In the second stage of DIC, the patient will have low platelet and fibrinogen levels and a prolonged clotting time.

Table 2: The scoring system used to diagnose DIC is shown below. DIC is diagnosed if the total score is 5 or higher.

People with DIC often also have a life-threatening condition that requires treatment. If the cause of DIC is unknown, specialists will therefore perform tests to identify the underlying health problem.

How Is DIC Treated?

The aim of DIC treatment is to control clotting or bleeding and treat the underlying condition causing it.

In the first stage of DIC, blood-thinning medicines may prevent organ damage by stopping blood clotting. However, a patient may reach the second stage and experience substantial bleeding or be at high risk of bleeding complications. They may then need transfusions of plasma, platelets or clotting factors.

Specialists consider platelet and plasma replacement only in the following situations:

If the person:

• Has active bleeding
• Has a high risk of bleeding
• Needs to undergo an invasive medical procedure

Treatment for the underlying condition will vary depending on the person's situation. For example:

• Antibiotic treatment for sepsis
• Surgery for people who may have internal injuries
• Early delivery, if possible, for pregnant patients with placental abruption

What Are the Complications of DIC?

DIC is a serious condition and can lead to certain complications:

• Life-threatening bleeding
• Gangrene (tissue death due to a lack of oxygen-rich blood)
• Stroke
• Venous thromboembolism
• Heart attack
• Acute kidney failure
• Medical shock

DIC can also cause a condition known as multiple organ dysfunction syndrome or multiple organ failure. This is potentially reversible but very serious, can develop rapidly and can cause death.

Some people with DIC may recover, but mortality is high. DIC can double the mortality rate in people with sepsis or trauma.

A person with acute, reversible DIC may recover completely. However, this depends on their condition and how quickly they begin receiving treatment. Diagnosing DIC at a very early stage and treating it promptly will increase the chance of a positive outcome.

Because DIC can affect many organ systems, recovery may take a long time. A team of healthcare professionals from multiple specialties will be needed for the person to survive and recover.

Summary

DIC is a condition that causes uncontrolled blood clotting. When the platelets and proteins responsible for forming blood clots are depleted, a person begins to bleed. This bleeding may occur in the mouth, rectum, vagina or under the skin.

DIC always occurs as a result of another health condition, and the underlying cause is generally a serious health problem.

Treatment involves controlling clotting and bleeding and treating the underlying cause as quickly as possible.

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Table 3: The following DIC treatment algorithm is intended for healthcare professionals: