Clinical Aspects of Disseminated Intravascular Coagulation: A Clinician's Point of View

Abstract

DIC is a disorder of coagulation that is demonstrated to occur in many settings. In view of the fulminant nature of the disorder once it is fully activated, the potential for considerable morbidity and mortality, and the difficulty in treating this syndrome, the necessity for a thorough understanding of the disorder is clear. A high index of suspicion is absolutely essential; however, this requires a thorough knowledge of the medical and surgical disorders in which DIC is likely to occur. The presenting manifestations of DIC, the time course of development of the fulminant syndrome, and the specific complications of the disorder may be intrinsically related to the specific clinical characteristics of the underlying disease. Clinical evaluation of the patient must be comprehensive and consider not only the laboratory and clinical manifestations of DIC but the triggering illness. Without the ability to treat the underlying primary illness, controlling or abating the DIC may be difficult or impossible. This comprehensive review of the disease entities in which DIC is likely to occur and the associated clinical manifestations will, it is hoped, guide a more precise definition of the overall clinical picture that confronts the clinician when evaluating a patient with possible DIC.

An experimental model of hemolysis-induced acute pancreatitis

“…Clearance of fibrinogen-fibrin split products was reduced during hemolysis because of the blockade of the reticuloendothelial system by cell detritus which, in a vicious cycle, promoted further coagulation system activation (24). Both the accumulation of activated coagulation factors and decreased reticuloendothelial clearance maintained the formation of microthrombi and associated microvascular disturbances, resulting in the functional impairment of several organs (25). Pancreatic microvascular control is a complex and incompletely understood physiological process (26).…”

Disseminated Intravascular Coagulation

“…Obstetrical accidents are common events leading to DIC. Amniotic fluid embolism with DIC is the most catastrophic and common of the life-threatening obstetrical accidents [1][2][3][4][5][6]. The syndrome of amniotic fluid embolism is manifest by the acute onset of respiratory failure, circulatory collapse, shock, and DIC.…”

“…DIC is an intermediary mechanism of disease usually seen in association with welldefined clinical disorders [1][2][3][4][5]. The pathophysiology of DIC serves as an intermediary mechanism in many disease processes, which sometimes remain organ specific.…”

“…Terminology following this phrase was 'defibrination syndrome' [8,9]; however, a more suitable term would be 'defibrinogenation syndrome'. The contemporary term is disseminated intravascular coagulation; this is a useful descriptive pathophysiological term if one accepts the concept that 'coagulation' is expressed as both hemorrhage and thrombosis [2][3][4][5]. Most physicians consider DIC to be a systemic hemorrhagic syndrome; however, this is only because hemorrhage is evident and often impressive.…”

Kidney Transplantation from Donors with Severe Disseminated Intravascular Coagulation

“…Clinical manifestations of DIC are variable and may include petechiae, purpura and other signs of abnormal bleeding, fever, hypotension, proteinuria, and hypoxia. Microvascular thrombosis can result in cardiac, pulmonary, renal, hepatic, and CNS dysfunction [4].…”