What causes disseminated intravascular coagulation?
Disseminated intravascular coagulation (DIC) is always secondary to an underlying disorder.
The pathological situations that cause DIC are shown in Table I.
DIC may be fulminant (progressing rapidly, sometimes overwhelming) or less severe.
Fulminant DIC can be a complication of the following clinical situations:
- severe bacterial infection due to Gram-positive or Gram-negative bacteria that can cause septic shock,
- severe trauma, for example crush injuries or extensive burns,
- certain obstetrical conditions, the main one being amniotic fluid embolism,
- intravascular haemolysis,
- some malignancies, particularly certain leukaemias or solid tumours (pancreas, prostate),
- certain liver disorders.
| Overt/decompensated DIC | |
|---|---|
| Infection • Gram-negative bacteria (endotoxins) • Gram-positive bacteria (mucopolysaccharides) |
Intravascular haemolysis • Haemolytic transfusion reaction • Haemolysis • Massive transfusion |
| Trauma • Severe tissue injury (burns, crush injury) • Head injury • Fat embolism |
Malignancy • Leukaemias (e.g. AML M3 and M4) • Solid tumours (e.g. pancreas and prostate) |
| Obstetrical complications • Amniotic fluid embolism • Abruptio placentae • Missed abortion • Eclampsia, abortion |
Toxicity • Drugs (e.g. amfetamines) Liver disorders • Acute liver failure • Cholestatic jaundice |
| Non-overt/compensated DIC | |
|---|---|
| Cardiovascular disease • Stent valves • Giant haemangiomas • Aneurysm |
Haematological diseases Inflammatory syndromes |
| Renal vascular disease |
Autoimmune diseases • Graft rejection |
Table I: The main disorders associated with DIC
(adapted from Prieto M. International Congress Series. 2002;1237:163–8)