Disseminated Intravascular Coagulation (DIC) is a rare life-threatening disease. In the early stages of this condition, DIC causes excessive blood clotting. Consequently, blood clots can reduce blood flow and prevent blood from reaching the body’s organs.
As the development of conditions, platelets and clotting factors are the substances in the blood that are responsible for forming blood clots will be depleted. When this happens, you can experience excessive bleeding.
Disseminated Intravascular Coagulation Definition
What is disseminated Intravascular coagulation (DIC)?
Disseminated Intravascular coagulation (DIC) is a condition of blood clotting in the body’s small blood vessels. This blood clotting can reduce or inhibit blood flow through blood vessels, which can damage the body’s organs.
At DIC, increased clotting using platelet and clotting factor in the blood. Platelet is a fragment of blood cells that attaches to close small wounds on the walls of blood vessels and stop bleeding. The clotting factor is the protein necessary for normal blood clotting.
With the least platelet and clotting factor in the blood, serious bleeding can occur. DIC is a condition that can cause internal and external bleeding.
Internal bleeding occurs on the inside of the body. External bleeding occurs below or from the skin or mucosa. (Mucosa is the tissue that coats some of the body’s organs and cavities, such as nose and mouth.)
Disseminated intravascular coagulation causes
DIC occurs due to excessive activity of the blood clotting factor. This can happen due to a variety of diseases. Among them are:
- Severe infections
- Sepsis (inflammation of all circulatory due to germ infection)
- Inflammation of the pancreas (pancreatitis)
- Complications in pregnancy like placental abruptio, heavy preeclampsia, and eclampsia
- The fetus dies in the womb (intrauterine fetal death/IUFD)
- Severe antiphospholipid syndrome
- Hepatic cirrhosis
- Injuries in the brain and nerves
- Extensive burns
- Snake venom
- Blood transfusion reaction
Symptoms of Disseminated Intravascular Coagulation
Symptoms of this disease are the emergence of excessive bleeding. This condition can occur from various locations in the body. Bleeding can also occur in mucosal tissues (in the mouth and nose) and even internal and external areas. Meanwhile, other symptoms that arise are:
- Blood clots;
- Decreased blood pressure;
- Easy bruising;
- Bleeding in the rectum or vagi**nal area;
- Appears red dots on the surface of the skin (petechiae).
Immediately go to the nearest hospital if you experience the above symptoms.
Read also: What Does A Blood Clot Feel Like?
Diagnosis of Disseminated Intravascular Coagulation
To determine the presence of intravascular coagulation, there are several mandatory laboratory tests to be conducted. The examination is the screening of platelets, activated partial thromboplastin time, prothrombin time, fibrinogen, and D-dimer. The examination will be required by the doctor to determine the condition of blood clotting in the sufferer.
Other tests to assess function of various organs are also performed. Among them are:
- Ureum and creatinine examination to assess renal function
- SGOT examination, SGPT, albumin to assess liver function
- Chest X-rays to see the picture of the lungs and heart.
Disseminated Intravascular Coagulation Treatment
Treatment of the trigger factor
A very important treatment at the DIC Fulminant is a progressive cure and eliminates DIC trigger. By treating the trigger factor, the DIC process can be reduced or stopped. Overcoming shock, removing the dead fetus, burning infections (sepsis), and restoring the volume can stop the DIC process.
Stopping or inhibiting coagulation process can be done by providing anticoagulant e.g. Heparin. Indications of giving Heparin:
- When a basic illness cannot be eliminated in a short time
- Patients who are still accompanied by bleeding even though basic diseases have been eliminated. This is because the DIC does not interfere with the coagulation process.
- When there is a sign / feared thrombosis occurs in microcirculation, renal failure, hepatic failure, the syndrome of failed breath.
The method of administration of the classic heparin
The method of administration of the classic heparin in DIC starts with a starting dose of 100 -200 π/kgbw intravenously and the next medications are determined based on the APTT or clotting period (CP) examined 2-3 hours after administration of heparin. APTT Target 1.5-2.5 times control or clotting time (CP) 2-3 times control.
When APTT is less than 1.5 controls or CP less than 2 times the control, the dose of heparin is raised.
If more than 2.5 times the APTT control or MP is more than 3 times the control then repeat 2 hours.
Then, if the APTT or MP is still more than 2.5-3 times the control, then the dose is increased, whereas if it is less, the dose is lowered. Heparin is given every 4-6 hours and the dose given ranges from 20,000-30,000 µ / day.
If the bleeding continues after treating the basic diseases and after administration of anticoagulants the possibility of the cause is a decrease in blood components are a deficiency of clotting factor.
For this, it can be given fresh frozen plasma (Fresh frozen plasma) or cryoprecipitate. When platelets descend to 25,000 or less, the administration of platelet concentrates needs to be given.
Antifibrinolytic such as Tranexamic acid or epsilon amino caproic acid (EACA) is only administered when there is no apparent thrombosis and very real fibrynolysis. Antifibrinolytic is not administered when DIC is still ongoing and is even contraindicated