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Disseminated Intravascular Coagulation (DIC), Chronic

 

 

Chronic DIC Overview:

  • DIC is seen in setting of sepsis, trauma or malignancy
  • fibrinolysis (hi ddimer) and thrombosis (dec. fibrinogen) are both activated
  • In Chronic DIC, pts are asymptomatic with increased  fibrin degradation products or have venous thrombosis, minor skin, and mucosal bleeding
  • Other lab abnormalities like hi PT, hi PTT, lo fibrinogen, lo platelets may not be present in chronic state
  • Chronic DIC occurs when small amounts of tissue factor are circulating, but liver and bone marrow replete the coagulation factors and platelets

 

  • Solid tumors are the most common cause of chronic DIC; chemo is another cause

 

  • Treatment is based on thrombocytopenia, bleeding or bleed risk
    • Most recommend platelet transfusion for
      • platelets <20 K
      • or <50K in the setting of bleed or hi risk of bleed
    • Most recommend FFP for hi INR or bleed
    • Most recommend Cryo-ppt for fibrinogen <50 (goal >100)


 

(Ellen Eaton MD, 11/29/10)