1% of all hospitalized patients are found to have DIC

It is an independent predictor of mortality for many of the common problems we see in the ED

Often, we don't see these complications until the patients have left the ED and is another reason why you should follow up on your admitted patients

There are 2 type of DIC
acute and chronic

Acute DIC develops when blood is exposed to procoagulants (tissue factor) or (tissue thromboplastin)

Chronic DIC develops reflects a compensated state when blood is intermittently exposed to TF or thromboblastin

4 simultaneous events take place:

1) Damaged cells, endothelial disruption, tumor secretion

infection, trauma, tumor, ob complications

4 things happen:

Via extrinsic pathway...

1) Generate thrombin through TF or tissue plasminogen (clotting)

2) Suppress anti-thrombin/Protein C (anti-clotting) (most important)
low levels increase mortality

3) Impaired fibrin removal

4) Concurrent Inflammatory reaction (SIRS)

-Clotting throughout
-Depletion of platelets
-Deplete of clotting factors
-Deposition of fibrin in end organs leading to small and medium vessels leading to MODS
This can been seen in acral cyanosis, hemmorhagic skin infarctions, and limb ischemia

The major causes of DIC
Sepsis, trauma, OB emergencies, Liver failure, Inappropriate flows (blood transfusions, LVADs)

As well, AML, Adenocarcinoma

The mortality rate for sepsis is reported around 20%

Typically, 30-50% of patients with sepsis will have DIC

Unlike traditional teaching can happen w/ both gram positive and gram negative bacteria as well as viral, fungal and parasitic infections (like malaria- which I hope I don't have)

DIC is in an INDEPENDENT predictor of mortality in patients with sepsis
- increases risk of death by a factor of 1.5-2

One study showed septic patients with DIC had a mortality rate of 34.7%

Specific complications:
Idopathic purpura fulminans has a mortality rate of 18%
-septic abortion w/ clostridial infection has mortality of 50% (why we look for retained products)
-

Trauma patients/Septic patients have the same SIRS inflammatory markers in their bloodstream

DIC increases mortality by 1.5-2 times

One of the main reasons to keep trauma patients warm is to prevent this complication

DIC in trauma doubles the mortality rate

typically caused by rush of procoagulant material

during pregnancy this is amniotic embolism, HELLP syndrome, placental abruption, acute fatty liver of pregnancy)

Malignancies like AML, ALL, mucin secreting adenocarcinoma