Disseminated Intravascular Coagulopathy (DIC)

Clinical description

Disseminated intravascular coagulopathy (DIC) is a bleeding and clotting disorder, secondary to underlying systemic process resulting in thrombin or plasmin dominance.

Signs and symptoms

History/Exam Evaluate for active vaginal bleeding (blood appears thin, without clots), Gastrointestinal bleeding, epistaxis, oozing from puncture and surgical wounds, purpura, oliguria, pulmonary oedema, reduced consciousness.

Investigations Check FBC (Hb, Platelets), clotting time (in red top tube blood should clot within 8 minutes), PT/PTT/fibrinogen (if available), abdominal ultrasound to evaluate for intraabdominal/pelvic bleeding

Treatment

Initial management

• Admit to HDU or ICU
• CAB (Circulation, Airway, Breathing), Oxygen
• Place 2 large bore (16 or 18 gauge) IV lines
• Place urinary catheter and monitor urine output every hour
• Contact blood bank immediately for blood products
• Give 2-6 units of whole blood if different components not available
• If components available, give 2-6 units PRBCs first to improve oxygenation
• Give 2-6 units FFP at 1:1 ratio with PRBCs
• Give platelets at 1-2 units/10 kg of actual body weight
• Give Cryoprecipitate at 10-20 ml/kg (4-6 units total) if FFP not available
• Initiate volume resuscitation immediately with 2L NS or RL until blood products arrive
• Evaluate and treat cause of bleeding
• If postpartum think of the “4 Ts” (Tone, Trauma, Tissue, Thrombin):

 Uterine Atony: Oxytocin 40 IU IV, Misoprostol 800-1,000 mcg PR, uterine massage, bimanual compression, intrauterine balloon, laparotomy (B-lynch, O’Leary’s, TAH)  Cervical/vaginal tears: Examination Under Anesthesia (EUA) in theatre and repair  Retained Tissue: manual removal of the placenta, evacuation with placental forceps  Thrombin disorder (DIC): give FFP and other blood products as noted above

• Other causes: macerated stillbirth, infection/sepsis
• Consider heparin if thrombosis is dominant

Clinical description