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Essentials of Diagnosis
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Associated with cancer, sepsis, trauma, and obstetrical patients
Prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), and low/declining fibrinogen
Thrombocytopenia
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General Considerations
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Results from uncontrolled local or systemic activation of coagulation, which leads to depletion of coagulation factors and fibrinogen and often results in thrombocytopenia as platelets are activated and consumed
Numerous disorders are associated with DIC
Aortic aneurysm and cavernous hemangiomas may promote localized intravascular coagulation
Snake bites may result in DIC due to the introduction of exogenous toxins
The HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a severe form of DIC with a particularly high mortality rate that occurs in peripartum women
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Bleeding usually occurs at multiple sites, such as at intravenous catheters or incisions, and may be widespread (purpura fulminans)
Malignancy-related DIC may manifest principally as thrombosis (Trousseau syndrome)
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Differential Diagnosis
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Severe liver disease
Thrombotic thrombocytopenic purpura
Sepsis-induced thrombocytopenia or anemia
Heparin-induced thrombocytopenia
Other microangiopathic hemolytic anemia (eg, prosthetic valve hemolysis)
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Underlying causative disorder must be treated (eg, antimicrobials, chemotherapy, surgery, or delivery of conceptus)
If clinically significant bleeding is present, hemostasis must be achieved; following is a strategy of managing DIC:
Assess for underlying cause of DIC and treat
Establish baseline platelet count, PT, aPTT, D-dimer, fibrinogen
Transfuse blood products if ongoing bleeding or high risk of bleeding
Platelets: goal > 20,000/mcL (20 × 109/L) (most patients) or > 50,000/mcL (50 × 109/L) (severe bleeding, eg, intracranial hemorrhage)
Cryoprecipitate: goal fibrinogen level > 80–100 mg/dL
Fresh frozen plasma: goal PT and aPTT < 1.5 × normal
Packed red blood cells: goal hemoglobin > 8 g/dL or improvement in symptomatic anemia
Follow platelets, aPTT/PT, fibrinogen every 4–6 hours or as clinically indicated
Heparin (initial infusion, 5–10 units/kg/h)