Disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC) is a condition where the blood clots too much. Blood clots develop in the bloodstream and can block small blood vessels in organs or limbs. With DIC, platelets and other blood clotting factors that are needed to control bleeding, or hemorrhage, are also lowered. When these blood clotting factors are low, too much bleeding can occur.
DIC is serious and needs to be treated right away. When it develops quickly, DIC can be life-threatening.
DIC can be caused by certain types of cancer, including:
- leukemia, especially acute promyelocytic leukemia (APL)
- solid tumour cancers, especially adenocarcinomas in the prostate, lung, breast or pancreas
- ovarian cancer
- kidney cancer
- stomach cancer
- gallbladder cancer
DIC can also be caused by other conditions such as severe sepsis, which is widespread infection in the blood or other tissues caused by bacteria. A severe reaction to a blood transfusion or liver failure from cancer that has spread, or metastasized, to the liver can also cause DIC.
Symptoms of DIC can vary. They may appear suddenly and can be severe. Symptoms of DIC include:
- bleeding and bruising easily
- shortness of breath
- pain or swelling in the arms and legs
- blood clots
- jaundice, which includes yellow skin and whites of the eyes
- low blood pressure
- low blood oxygen levels, or hypoxia
- multiple organ failure, including the liver, heart, central nervous system, kidney and lungs
Many people can have DIC and not know it until severe bleeding develops. Bleeding may occur at an intravenous site or in the gums, brain, skin, muscles, digestive tract or abdominal cavity.
Report symptoms to your doctor or healthcare team as soon as possible.
Your doctor will try to find the cause of DIC. This includes asking you questions about your symptoms and carefully assessing them. You will also have the following blood tests:
- complete blood count (CBC) to measure the number of platelets
- prothrombin time (PT) to measure how long it takes blood to clot
- plasma fibrinogen level to measure the amount of fibrinogen, a protein that is needed for blood to clot
- fibrin degradation products (FDP) test to measure the amount of proteins made when the body breaks up blood clots
Treating DIC @(Model.HeadingTag)>
Once the cause of DIC is known, your healthcare team can treat it. They may use the following measures to treat DIC.
You may need a transfusion of blood products such as platelets, red blood cells, fresh frozen plasma or other clotting factors. These products help stop bleeding and replace the blood clotting factors that are low.
You may be given oxygen therapy if your blood oxygen levels are low. You may also be given fluids by intravenous, which means they are given through a needle in a vein. This helps replace fluids in your body and increase your blood pressure.
Your healthcare team may prescribe medicines to help treat DIC. You may be given heparin, which is an anticoagulant, or blood thinner. It is used to slow or stop the clotting process. You may also be given fibrinolytic inhibitors. These drugs stop the breakdown of blood clots and control bleeding. Some people are given tranexamic acid (retinoic acid) to treat acute promyelocytic leukemia if there is a high risk that they will develop DIC.
Expert review and references
Casciato DA, Territo MC . Hematologic complications. Casciato DA & Territo MC (eds.). Manual of Clinical Oncology. 7th ed. Lippincott Williams & Wilkins; 2012: 34: pp. 784 - 812.
Gobel BH . Disseminated intravascular coagulation. Yarbro, CH, Wujcki D, & Holmes Gobel B. (eds.). Cancer Nursing: Principles and Practice. 7th ed. Sudbury, MA: Jones and Bartlett; 2011: 38: pp. 928 - 938.
Kaplan M . Disseminated intravascular coagulation. Kaplan M (Ed.). Understanding and Managing Oncologic Emergencies. 2nd ed. Pittsburgh: Oncology Nursing Society; 2013: 3: pp. 69 - 102.
Levi MM . Disseminated intravascular coagulation. eMedicine.Medscape.com. WebMD LLC; 2012.
Maoke JL . Disseminated intravascular coagulation (DIC). Beers, M. H., & Berkow, R., (Eds.). Merck Manual for Healthcare Professionals. Rahway, NJ: Merck Research Laboratories; 2013.