Disseminated Intravascular Coagulation: Pathophysiology, Laboratory Findings, and Diagnosis

Introduction

Disseminated Intravascular Coagulation (DIC) is a complex pathological condition characterized by widespread activation of the coagulation system, resulting in thrombosis and bleeding. It is often associated with underlying medical disorders such as sepsis, trauma, and malignancies.

Pathophysiology

DIC results from excessive activation of coagulation pathways due to systemic inflammation or endothelial damage. This leads to increased thrombin generation and fibrin deposition, causing microvascular thrombosis. Simultaneously, depletion of coagulation factors and platelets leads to a bleeding tendency.

Laboratory Findings

• Elevated D-dimer levels indicate excessive fibrinolysis.
• Prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) reflect coagulation factor consumption.
• Low platelet count due to increased consumption.
• Decreased fibrinogen levels.

Diagnosis

DIC is diagnosed based on clinical presentation and laboratory tests. Scoring systems such as the ISTH DIC score help assess severity and guide treatment.

Treatment Strategies and Management Approaches

Supportive Care

• Addressing the underlying cause is crucial for management.
• Fluid resuscitation to maintain hemodynamic stability.

Coagulation Support

• Platelet transfusions for severe thrombocytopenia.
• Fresh Frozen Plasma (FFP) for coagulation factor replenishment.
• Anticoagulants like heparin in cases of predominant thrombosis.

Monitoring

Continuous evaluation of coagulation markers and clinical signs is vital to ensure appropriate intervention.

Conclusion

Disseminated Intravascular Coagulation is a life-threatening condition requiring prompt diagnosis and targeted management. Early intervention can improve prognosis and patient outcomes.