Consumption Coagulopathy Treatment & Management

  • Author: Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: Oct 26, 2011
 

Medical Care

The most important concept in disseminated intravascular coagulation (DIC) is that it is a secondary manifestation of an underlying disorder.

The most important therapeutic maneuver is treating the initiating disorder. Without this, supportive measures ultimately fail.

Shock is a frequent underlying factor, and important supportive measures include ventilatory support, volume support, and pressor support as well as close monitoring of neurologic and renal function. Dialysis may be needed.

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Surgical Care

Involve a pediatric surgeon, as the underlying disorder indicates.

Surgical complications may include thrombotic occlusion of an artery with imminent loss of limb or organ function, bleeding, or compartment syndrome.

DIC can result in bleeding at any surgical site.

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Consultations

DIC is a complex pediatric disease that is best treated in tertiary care centers by using a multidisciplinary approach. Involving many services may be appropriate.

Hematologist-oncologist

Treatment involves complex decisions regarding differential diagnosis and treatment options.

Involve a pediatric hematologist early.

If DIC is thought to be secondary to malignancy, a pediatric oncologist can expedite diagnosis.

Intensivist

Most children with DIC are critically ill and require monitoring available in the pediatric ICU.

Many children develop shock and respiratory failure and require ventilatory support.

Blood bank specialist

Treatment of patients may involve blood products.

Blood bank specialists can provide resource advice on treatment decisions.

Infectious disease specialist

Many children with DIC have underlying sepsis that requires aggressive management.

Nephrologist

Renal derangement is not uncommon because thrombosis and shock interfere with renal perfusion.

Neurologist

DIC may cause neurologic symptoms related to CNS thrombosis, infarction, or hemorrhage.

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Contributor Information and Disclosures
Author

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP  Associate Professor of Pediatric Hematology and Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute

Vikramjit S Kanwar, MD, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sills, MD  Professor of Pediatrics, Upstate Medical University

Richard H Sills, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary R Jones, MD  Associate Medical Director, Clinical Development, Berlex Laboratories

Gary R Jones, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Gary D Crouch, MD  Associate Professor, Program Director of Pediatric Hematology-Oncology Fellowship, Department of Pediatrics, Uniformed Services University of the Health Sciences

Gary D Crouch, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Samuel Gross, MD  Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Paul J Galardy, MD, Eric Grabowski, MD, ScD, and Jennifer Boden Cerone, MD, to the development and writing of this article.

References

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Purpura fulminans.
Peripheral blood of a child with disseminated intravascular coagulation demonstrates thrombocytopenia and many schistocytes (Wright stain, original magnification X 1000).
Table. DIC Scoring System
MeasureScore
0123
Platelet count>100 X 109/L< 100 X 109/L< 50 X 109/LNA
PT prolongation, s0-33-66NA
Fibrinogen level (mg/dL)>100< 100NANA
Fibrin split productsNANA++++
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