D65/D68.2/D68.8
DIC is a complication of an underlying condition and is characterised by widespread activation of clotting cascade leading to consumption of clotting factors and platelets with generalized bleeding. No single diagnostic test, but the combination of a prolonged INR and PTT, thrombocytopenia, decreased fibrinogen and increased D-dimer is highly suggestive of the diagnosis.
MANAGEMENT
Identify and treat the underlying cause.
If the patient is bleeding, replace haemostatic factors with cryoprecipitate or FFP/lyophilised plasma.
If the patient is not actively bleeding and platelet count > 20 x 109/L, then platelet transfusion is not necessary.
Replacement therapy for thrombocytopenia should consist of 1 apheresis single donor unit or 1 pooled random donor unit. In chronic DIC, or in the absence of bleeding, platelet transfusions should not be given merely to correct the thrombocytopenia.
For hypofibrinogenaemia:
- Cryoprecipitate, IV, 1 unit/10 kg.
For depletion of other coagulation factors:
- Lyophilised plasma, IV, 15 mL/kg as initial dose
- Volume: ±200 mL/unit.
OR
FFP, IV, 15 mL/kg as initial dose.
- Volume: ±280 mL/unit.
Repeat replacement therapy 8 hourly or less frequently, with adjustment according to the clinical picture and laboratory parameters.
Monitor response with frequent estimation of the platelet count and coagulation screening tests.