Summary
Definition
History and exam
Key diagnostic factors
- presence of underlying disorders
- oliguria, hypotension, or tachycardia
- purpura fulminans, gangrene, or acral cyanosis
- delirium or coma
- petechiae, ecchymosis, oozing, or hematuria
Risk factors
- major trauma/burn/organ destruction or sepsis/severe infection
- severe obstetric disorders or complications
- solid tumors and hematologic malignancies
- severe toxic or immunologic reactions
- major vascular disorders (large aortic aneurysms or giant hemangiomas)
Diagnostic tests
1st tests to order
- platelet count
- prothrombin time (PT)
- fibrinogen
- D-dimer/fibrin degradation products
- activated partial thromboplastin time (aPTT)
- imaging studies or other tests
Tests to consider
- thrombin time
- factor V, VIII, X, XIII
Emerging tests
- inflammatory cytokines
- D-dimer (monoclonal antibody test)
- antithrombin III
- fibrinopeptide A (FPA)
- prothrombin fragment 1 and 2
Treatment algorithm
low bleeding risk
high bleeding risk or active bleeding
chronic DIC
Contributors
Authors
Haibo Wang, MD, PhD
Assistant Professor - Gratis
LSU Health Sciences Center Shreveport (LSUHSC-S)
Shreveport
LA
Staff Anesthesiologist
JPS Health Network
Department of Anesthesiology
Fort Worth
TX
Disclosures
HW declares that he has no competing interests.
Acknowledgements
Dr Haibo Wang would like to gratefully acknowledge Dr Frank G. Zavisca, a previous contributor to this topic.
Disclosures
FGZ declared he had no competing interests.
Peer reviewers
Alan Kaye, MD, PhD, DABPM
Professor and Chairman
Department of Anesthesiology
LSU School of Medicine
New Orleans
LA
Disclosures
AK is on the speakers' bureau of Baxter Corporation and Hospira Corporation.
Cheng-Hock Toh, MB, ChB, MD, FRCP, FRCPath
Professor of Haematology
University of Liverpool
Liverpool
UK
Disclosures
CHT is an author of a reference cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Franchini M, Lippi G, Manzato F. Recent acquisitions in the pathophysiology, diagnosis and treatment of disseminated intravascular coagulation. Thromb J. 2006 Feb 21;4:4.Full text Abstract
Taylor FB Jr, Toh CH, Hoots WK, et al; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society of Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001 Nov;86(5):1327-30. Abstract
Levi M, Toh CH, Thachil J, et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009 Apr;145(1):24-33.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Severe liver failure
- Heparin-induced thrombocytopenia
- Idiopathic purpura fulminans
More DifferentialsGuidelines
- Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC and ISTH
- Guidelines for the diagnosis and management of disseminated intravascular coagulation (amendment to recommendation for activated protein C)
More GuidelinesPatient information
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