DIC (disseminated intravascular coagulation)

- Release of pro-coagulant material into circulation or endothelial cell damage causes generalized activation of the coagulation and fibrinolytic pathways, resulting in widespread fibrin deposition

Causes:

Infection

- Meningitis

- Septicaemia

- Severe malaria

Malignancy

- Disseminated adenocarcinoma

- Acute promyelocytic leukaemia (type AMLM3)

Obstetric

- Septic abortion

- Retained products of conception

- Amniotic fluid embolism

Miscellaneous

- Fulminant liver disease

- Trauma

- Burns

- Hypersensitivity

Clinical features:

- Bleeding and thrombosis

- ARDS

- Renal failure, adrenal necrosis (due to microvascular thrombosis)

- Liver dysfunction

- GI bleeding

- Skin ecchymoses and purpura

- Thromboembolism

Treatment:

a) Treat the cause (e.g. antibiotics for septicaemia, removal of pro-coagulant stimulus [e.g. dead fetus])

b) Supportive therapy (e.g. FFP, platelet concentrates, cryoprecipitate)