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)