Potentially life-threatening emergency
Disseminated intravascular coagulation in Adult
Alerts and Notices
Synopsis
DIC may be triggered by a variety of conditions, including trauma or burns, severe infections or sepsis, obstetrical complications, malignancies, severe snakebite reactions, and giant hemangiomas. Systemic signs and symptoms may include mental status changes, fever, dyspnea, hypotension, tachycardia, hematuria, and oliguria. Dermatologic signs include mucosal bleeding, retiform purpura, petechiae, and acral gangrene. In severe cases, fatality may occur rapidly. Complications from DIC include acute renal failure, severe hemorrhage in various locations (eg, cardiac tamponade, intracerebral hemorrhage, hemothorax), and gangrene.
DIC may be acute, chronic, or localized. Severe acute DIC is a medical emergency generally caused by trauma, malignancy, infection, or an obstetric emergency. It often presents with generalized bleeding and a shock-like picture (hypotension and tachycardia). Chronic DIC demonstrates subacute bleeding and diffuse thrombosis; its causes are often malignancies, other obstetrical complications, and autoimmune / inflammatory disorders. Many patients with low-grade chronic DIC can be managed on an outpatient basis. Localized DIC, as the name suggests, is confined to a specific body location. It is associated with giant hemangiomas (Kasabach-Merritt syndrome), aortic aneurysms, and hyperacute kidney transplant rejection.
Codes
ICD10CM:D65 – Disseminated intravascular coagulation [defibrination syndrome]
SNOMEDCT:
67406007 – Disseminated intravascular coagulation
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Coumadin (warfarin) necrosis
- Heparin necrosis
- Antiphospholipid antibody syndrome
- Recluse spider envenoming
- Acute meningococcemia
- Cryoglobulinemia
- Cryofibrinogenemia
- Necrotizing fasciitis
- Large vessel vasculitis
- Thrombotic thrombocytopenic purpura
- Idiopathic purpura fulminans
- Cocaine levamisole toxicity
- Localized trauma
- Primary bone marrow failure – such as an infiltrative process or leukemia
- HELLP syndrome (hemolysis, elevated liver function tests, low platelets) in pregnant patients
- Primary fibrinolysis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/15/2017
Last Updated:08/02/2021
Last Updated:08/02/2021
Potentially life-threatening emergency
Disseminated intravascular coagulation in Adult