ICU · Haematology

Disseminated intravascular coagulation: ISTH score, transfusion, and management

Also known as DIC · Disseminated intravascular coagulation · Consumptive coagulopathy · ISTH overt-DIC score

Disseminated intravascular coagulation (DIC) = systemic activation of coagulation - microvascular thrombosis + consumption of platelets/clotting factors - BLEEDING + THROMBOSIS simultaneously. CAUSES: sepsis (most common — 50%), trauma, malignancy (leukaemia, solid tumour — mucin), obstetric (amniotic fluid embolus, placental abruption, severe pre-eclampsia/HELLP), transfusion reaction, snake bite, severe liver disease. CLINICAL: BLEEDING (oozing from IV sites, gums, GI, GU, petechiae, ecchymoses — from consumed platelets/factors) + THROMBOSIS (purpura fulminans, digital ischaemia, AKI, ARDS, MOF — from microvascular clots). DIAGNOSIS: ISTH overt-DIC score (platelets, fibrinogen, FDP/D-dimer, PT — score ≥5 = overt DIC). MANAGEMENT: TREAT THE UNDERLYING CAUSE (the 1 priority — antibiotics for sepsis, delivery for obstetric, etc.) + SUPPORTIVE (transfuse platelets/fresh frozen plasma/cryoprecipitate if bleeding or high risk — NOT prophylactically) ± ANTICOAGULATION (controversial — for thrombotic DIC — heparin). MORTALITY: 40-80% (high — reflects underlying severity).