🩸 Disseminated Intravascular Coagulation (DIC): The Bleeding-Thrombosis Paradox
Disseminated Intravascular Coagulation (DIC) is a life-threatening coagulopathy often secondary to other critical conditions like sepsis, obstetric complications, or trauma. It's frequently tested because of its paradoxical presentation: bleeding and clotting.
USMLE Clue: Bleeding + thrombosis + elevated D-dimer = Think DIC
🧬 Pathophysiology Summary
Systemic activation of clotting cascade
Microthrombi → organ ischemia
Consumption of clotting factors and platelets → bleeding
Triggered by endothelial injury, tissue factor release, or massive inflammation
🧪 Classic Causes of DIC
| Category | Examples |
|---|---|
| Sepsis | Gram-negative bacteria, meningococcemia |
| Trauma | Burns, crush injuries |
| Obstetric | Abruptio placentae, amniotic fluid embolism |
| Malignancy | AML (M3), adenocarcinomas |
| Other | Liver failure, transfusion reaction, snake venom |
🩺 Clinical Presentation
| Finding | Description |
|---|---|
| Bleeding | IV sites, gums, petechiae, ecchymosis |
| Thrombosis | Digital ischemia, renal infarcts, stroke |
| Shock | Due to blood loss or organ failure |
| Organ dysfunction | Renal, respiratory, CNS failure |
| Purpura fulminans | Skin necrosis (esp. in children) |
🧪 Laboratory Findings
| Test | Result |
|---|---|
| Platelets | ↓↓↓ |
| PT & aPTT | ↑↑ |
| Fibrinogen | ↓ |
| D-dimer | ↑↑↑ |
| Peripheral smear | Schistocytes present |
USMLE Tip: DIC = increased PT/PTT, low platelets, low fibrinogen, high D-dimer
💊 Management Strategy
| Step | Intervention |
|---|---|
| 1 | Treat underlying cause (e.g., infection, delivery) |
| 2 | Supportive care (IV fluids, oxygen, pressors if needed) |
| 3 | Transfusions: platelets, FFP, cryoprecipitate if bleeding |
| 4 | Heparin in thrombosis-predominant DIC (rare) |
| 5 | Monitor organ function (renal, lungs, CNS) |
📚 Sample USMLE Vignette
A 32-year-old woman with abruptio placentae develops oozing from IV lines and petechiae. Labs show platelet count 40k, fibrinogen 110 mg/dL, PT 25 sec, and D-dimer elevated. What’s the diagnosis?
✅ Answer: DIC (Disseminated Intravascular Coagulation)
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