Definition
- Disseminated intravascular coagulation (DIC) is a pathologic syndrome that arises from a heterogeneous group of medical disorders.
- Simultaneous activation of both clotting and fibrinolysis, resulting in severe bleeding
- DIC is always a secondary phenomenon and not a disease entity in its own right.
- Because of variable clinical manifestations and heterogeneity of primary disorders, DIC is also known as:
- Consumptive coagulopathy
- Hemorrhagic syndrome
- Defibrination syndrome
- Consumptive thrombohemorrhagic disorder
Epidemiology
- Prevalence
- Seen in ~0.4–1% of hospitalized children
- Infection is a contributing factor in almost 95% of children with DIC.
- Multiorgan dysfunction is present in almost 85%.
- Incidence by underlying disease process is unknown.
Etiology
- The normal physiology of coagulation is disturbed by the simultaneous action of 4 mechanisms.
- Increased thrombin generation
- Suppressed physiologic anticoagulant pathways
- Activation and subsequent impairment of fibrinolysis
- Activation of the inflammatory pathway
- Steps in DIC
- During an inciting event (eg, sepsis), monocytes and endothelial cells are injured by toxic substances elaborated during the disease process.
- They generate tissue factor, which activates the coagulation cascade.
- Continuous activation of coagulation leads to unregulated or explosive generation of thrombin.
- Depletes clotting factors and platelets
- Activates the fibrinolytic system
- Activation of clotting leads to generalized fibrin deposition and microthrombi formation.
- Microthrombi deposit in various organs, leading to tissue ischemia and multiorgan failure.
- Deposition of fibrin in microvasculature leads to mechanical fragmentation of erythrocytes, causing microangiopathic hemolytic anemia.
- Impaired anticoagulant pathway function can amplify thrombin generation and contribute to fibrin formation.
- Plasma levels of antithrombin are reduced in patients with sepsis, and significant depression of the activated protein C system may occur.
- Initial hyperfibrinolytic response causes clot lysis, contributing to cutaneous hemorrhages and bleeding into internal organs.
Risk Factors
- Sepsis
- Trauma
- Systemic inflammatory syndrome
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