Causes, Risk Factors, And Complications Of Disseminated Intravascular Coagulation (DIC)

Disseminated intravascular coagulation (DIC) is a condition that causes the production of blood clots in an individual's small blood vessels that can obstruct blood flow to organs in the affected region. Clotting factors and platelets are components of the blood required for the appropriate and effective formation of blood clots. DIC is a condition where the clotting factors become more active than normal, resulting in an inappropriate formation of blood clots. This condition can be acute and occur suddenly, or it may be chronic and develop slowly. Diagnosis of disseminated intravascular coagulation is made through a thorough physical exam, medical history, complete blood count, blood smear, serum fibrinogen, and fibrin degradation tests, among others. Treatment is based on symptoms and may include blood transfusions, oxygen therapy, and other medications.

There are several causes and risk factors associated with disseminated intravascular coagulation, and numerous complications can arise from it. Get to know them now.

Infection Or Inflammation

Disseminated intravascular coagulation may be caused by an individual's infection or inflammation. The most common type of bacterial infections implicated in the development of DIC is gram-positive blood infections, rickettsia infections, and gram-negative blood infections. Some viral infections have also been implicated in the development of DIC, including HIV, varicella-zoster virus, cytomegalovirus, and hepatitis viruses. Fungal Histoplasma infections and parasitic malaria infections have also been seen to induce disseminated intravascular coagulation. The systemic influx of proinflammatory cytokines results from a microorganism's specific cell membrane components, like endotoxins and lipopolysaccharide. Large amounts of cytokines can stimulate the production and expression of a tissue factor that initiates the coagulation cascade, ultimately resulting in inappropriate thrombin formation. Infections such as pancreatitis are known to directly activate clotting factor X and elevating the activity of thrombin in the systemic circulation, causing the inappropriate formation of clots. Because they are a probable cause, individuals who contract such infections or have systemic inflammation are at an increased risk of developing DIC.

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Brain Or Crush Injuries

An individual who has experienced brain or crush injuries is at an increased risk of developing DIC due to the association between it and severe trauma. Brain injuries that occur due to trauma and crush injuries have the potential to induce disseminated intravascular coagulation through a combination of different mechanisms. Crush injuries are known to cause a mass rupture of thousands of cells simultaneously upon bodily impact. This cause of cellular apoptosis induces the bulk release of tissue materials such as phospholipids and tissue factor into the patient's systemic circulation. Crush injuries also cause a large volume of hemolysis (red blood cell destruction) on top of extensive damage to the blood vessel walls. A combination of one or more of these mechanisms is thought to induce the reactive activation of the coagulation cascade in multiple systems in the body. Individuals who suffer from the brain or crush injuries involving trauma have almost identical sequencing of system-wide inflammatory cytokines as patients affected by a septic infection of the blood. While it is difficult to pinpoint the exact processes of DIC development in every brain and crush injury patient, the release of materials, extensive damage, and actions of a mass cytokine influx are all thought to play key roles.

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Surgery

An individual who undergoes invasive or major surgery is at an increased risk of developing DIC following the procedure. Surgical stress following a major procedure is known to induce early system-wide leukocytosis, as are elevated cortisol levels and administration of adrenaline during the procedure. A serious condition called systemic inflammatory response syndrome (SIRS) may develop due to the effects of surgical stress, which is known to throw off the healthy regulation of certain types of cytokines. SIRS may progress into full-blown septicemia in patients within a day following their surgery. Upregulation of the actions of chemical mediators can cause the affected individual to go into a hypercoagulable state, which has the potential to trigger disseminated intravascular coagulation. Any patient who undergoes a surgical procedure involving a large blood loss like cardiac surgeries is at an increased risk of developing DIC. Acute large volume blood loss and the administration of subsequent blood transfusions within a limited period can trigger DIC as well. Some patients who have an acute hemorrhage during surgery experience an abnormal and exaggerated reaction that involves the activation and upregulation of the coagulation cascade, which has the potential to trigger disseminated intravascular coagulation.

Learn about quite the common risk factor for DIC for women now.

Delivered A Baby

Certain individuals who have recently delivered a baby are at an increased risk of developing disseminated intravascular coagulation. Certain complications that occur in a woman who delivers a child are known to be associated with the development of DIC and include placental abruption, severe preeclampsia, eclampsia, retained dead fetus, hypovolemia, acute fatty liver of pregnancy, amniotic fluid embolism, placenta previa, HELLP syndrome, delayed miscarriage, and septicemia. Several alterations occur in clotting factors and other substances involved with the clotting process during a woman's pregnancy. These alterations result in a normal elevation of clotting factors and a mild hypercoagulable state that usually disseminates within several months following childbirth. When a complication during or following childbirth occurs that involves massive hemorrhage despite the natural preparations the body has made, the excessive loss of blood in combination with existing hypercoagulability can trigger DIC. In such cases, the body experiences widespread fibrin displacement due to system-wide activation of the coagulation cascade. Clots form in the microvessels and can cause organic failure.

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Excessive Bleeding

Excessive bleeding is known not only as a potential cause of DIC, but it is also a serious and life-threatening complication that arises in a portion of affected individuals. The increased coagulability in disseminated intravascular coagulation patients leads to the formation of numerous clots in the microvessels throughout the body. In acute cases, there is a point where the increased clotting activity exceeds the availability of clotting resources such as platelets and clotting factors. Clotting activity exhausts platelets and clotting proteins to the extent where limited amounts are left to carry out normal clotting processes when they are actually needed. This malfunction can cause the patient to experience varying degrees of internal and or external bleeding. Internal bleeding can happen in tissues of the individual's brain, kidneys, and intestines. External bleeding has been reported from or underneath the patient's skin and mucosa. Blood in the urine, blood in the stool, headaches, seizures, and double vision are symptoms reported in cases where DIC has been complicated by excessive bleeding.