Disseminated intravascular coagulation (
DIC) is a syndrome of deposition of platelet-
fibrin thrombi in the microcirculation, with consumption of platelets and
clotting factors and possible clinical features of
bleeding or
thrombosis or both. It may be produced by activation of coagulation, platelet aggregation or endothelial damage. It is not a primary disease, but a common and important complication of many serious illnesses, especially
sepsis,
carcinoma and obstetrical accidents.
Shock and
acidosis are frequent precipitating factors, and
vitamin K deficiency is a common complicating factor.
DIC usually produces no clinical features, but it may give rise to
bleeding, ischemic organ damage or
shock. Although its clinical contribution is often difficult to separate from that due to the underlying disease,
DIC remains the commonest cause of a generalized
bleeding tendency in acutely sick patients. Laboratory confirmation consists of the demonstration of
thrombocytopenia, coagulation impairment, hypofibrinogenamia, raised levels of
fibrin degradation products, and positive results of para-coagulation tests. The most important therapeutic measure is control of the underlying disease, but replacement
therapy and
heparin may be required, especially if
bleeding is significant and the process is not acute and self-limited.