Disseminated Intravascular Coagulation (DIC)
Disseminated intravascular coagulation (DIC) is a rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels. You may develop DIC if you have an infection or injury that affects the body’s normal blood clotting process.
DIC progresses through two stages: overactive clotting followed by bleeding.
- In stage one, overactive clotting leads to blood clots throughout the blood vessels. The clots can reduce or block blood flow, which can damage organs.
- In stage two, as DIC progresses, the overactive clotting uses up platelets and clotting factors that help the blood to clot. Without these platelets and clotting factors, DIC leads to bleeding just beneath the skin, in the nose or mouth, or deep inside the body.
What are the symptoms of DIC?
If you think you might have DIC, watch for the following symptoms:
- Bleeding at wound sites or from the nose, gums, or mouth
- Blood in the stool or urine
- Bruising in small dots or larger patches on the body
- Chest pain
- Pain, redness, warmth, and swelling of the leg
What causes DIC?
DIC is usually caused by inflammation from an infection, injury, or illness. Some common causes include:
- Sepsis: This is a body-wide response to infection that causes inflammation. Sepsis is the most common risk factor for DIC.
- Major damage to organs or tissues: This may be caused by cirrhosis of the liver, pancreatitis, severe injury, burns, or major surgery.
- Severe immune reactions: Your body may overreact because of a failed blood transfusion, rejection of an organ transplant, or a toxin such as snake venom.
- Serious pregnancy-related problems: These include the placenta separating from the uterus before delivery, amniotic fluid entering the bloodstream, or serious bleeding during or after delivery.
DIC is a rare complication of COVID-19. People who develop DIC are more likely to have severe complications, like organ failure, that can often be life-threatening.
How is DIC diagnosed?
Your doctor will diagnose DIC based on your medical history, a physical exam, and tests. Your doctor will also look for the cause of DIC, because it does not occur on its own.
Medical history and physical exam
To help diagnose DIC, your doctor will ask about any medical conditions or recent events, such as illness or an injury, that could cause or be a risk factor for DIC. Your doctor will do a physical exam to look for symptoms of blood clots, bleeding, or a condition that could cause DIC or a complication of DIC.
If your doctor suspects DIC, they may do several blood tests. Based on the results of your blood tests, your doctor may use a scoring system to diagnose DIC. The higher the score, the more likely it is that you have DIC. To make a diagnosis, your doctor may repeat some tests and watch your condition over time.
Tests for other medical conditions
Your doctor may suggest other tests or procedures to find out whether a different condition is causing your symptoms. These tests may include:
- ADAMTS13 testing to check blood levels and activity of this protein, which can be low in a condition called thrombotic thrombocytopenic purpura
- Liver biopsy and liver function tests to check for cirrhosis or chronic liver disease, which may have symptoms like DIC
How is DIC treated?
Treatment for DIC depends on your symptoms and how serious they are. The main goals of treatment for DIC are to control clotting and bleeding and to treat the underlying cause. DIC may go away once the underlying cause is treated. In the meantime, your doctor may use medicines or procedures to help stop the bleeding.
Your doctor may use anticoagulants, also called blood thinners, to reduce blood clotting. You may be given them as a pill, as an injection, or through an IV. Possible side effects include bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
Procedures and therapies
Common treatment options include:
- Clotting factor replacement therapy
- Plasma transfusion
- Platelet transfusion
Without treatment, DIC can lead to complications caused by overactive clotting or from the bleeding that follows. These complications can be life-threatening and may include:
- Acute respiratory distress syndrome (ARDS)
- Bleeding in the gastrointestinal tract
- Heart attack
- Venous thromboembolism