Disseminated Intravascular Coagulation Clinical Presentation

Updated: Sep 29, 2016
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Presentation

History

The symptoms of disseminated intravascular coagulation (DIC) are often those of the underlying inciting condition (see Etiology). Such conditions may include the following:

In addition to the symptoms related to the underlying disease process, there is typically a history of blood loss through bleeding in areas such the gingivae and the gastrointestinal (GI) system (see Table 3 below). [42] Acutely presenting DIC often manifests as petechiae and ecchymosis, along with blood loss from intravenous (IV) lines and catheters. In postoperative DIC, bleeding can occur in the vicinity of surgical sites, drains, and tracheostomies, as well as within serous cavities.

Table 3. Main Features of Disseminated Intravascular Coagulation in Series of 118 Patients (Open Table in a new window)

Features Affected Patients, %
Bleeding 64%
Renal dysfunction 25%
Hepatic dysfunction 19%
Respiratory dysfunction 16%
Shock 14%
Central nervous system dysfunction 2%

Look for symptoms and signs of thrombosis in large vessels (eg, deep vein thrombosis [DVT]) and microvascular thrombosis (as in renal failure). Bleeding from at least 3 unrelated sites is particularly suggestive of DIC. As many as 25% of patients present with renal failure. Patients with pulmonary involvement can present with dyspnea, hemoptysis, and cough. Comorbid liver disease as well as rapid hemolytic bilirubin production may lead to jaundice. Neurologic changes (eg, coma, obtunded mental status, and paresthesias) are also possible.

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Physical Examination

With acute DIC, the physical findings are usually those of the underlying or inciting condition; however, patients with the acute disease (ie, the hemorrhagic variety associated with excess plasmin formation) have petechiae on the soft palate, trunk, and extremities from thrombocytopenia and ecchymosis at venipuncture sites. These patients also manifest ecchymosis in traumatized areas.

In patients with so-called chronic or subacute DIC, of which the primary manifestation is thrombosis from excess thrombin formation, the signs of venous thromboembolism may be present.

Circulatory signs include the following:

  • Signs of spontaneous and life-threatening hemorrhage
  • Signs of subacute bleeding
  • Signs of diffuse or localized thrombosis
  • Bleeding into serous cavities

Central nervous system signs include the following:

  • Nonspecific altered consciousness or stupor
  • Transient focal neurologic deficits

Cardiovascular signs include the following:

  • Hypotension
  • Tachycardia
  • Circulatory collapse

Respiratory signs include the following:

  • Pleural friction rub
  • Signs of acute respiratory distress syndrome (ARDS)

Gastrointestinal signs include the following:

  • Hematemesis
  • Hematochezia

Genitourinary signs include the following:

  • Signs of azotemia and renal failure
  • Acidosis
  • Hematuria
  • Oliguria
  • Metrorrhagia
  • Uterine hemorrhage

Dermatologic signs include the following:

  • Petechiae
  • Jaundice (liver dysfunction or hemolysis)
  • Purpura
  • Hemorrhagic bullae
  • Acral cyanosis
  • Skin necrosis of lower limbs (purpura fulminans)
  • Localized infarction and gangrene
  • Wound bleeding and deep subcutaneous hematomas
  • Thrombosis
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