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.
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.
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. [21]
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Purpura fulminans.
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Peripheral blood of a child with disseminated intravascular coagulation demonstrates thrombocytopenia and many schistocytes (Wright stain, original magnification X 1000).
Tables
Measure |
Score |
|||
0 |
1 |
2 |
3 |
|
Platelet count |
>100 X 109/L |
< 100 X 109/L |
< 50 X 109/L |
NA |
PT prolongation, s |
0-3 |
3-6 |
6 |
NA |
Fibrinogen level (mg/dL) |
>100 |
< 100 |
NA |
NA |
Fibrin split products |
NA |
NA |
+ |
+++ |
