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Disseminated Intravascular Coagulation (DIC) is a life-threatening coagulopathy characterized by widespread activation of the clotting cascade, leading to simultaneous thrombosis and bleeding. This condition represents a secondary process triggered by various underlying diseases including sepsis, malignancy, trauma, or obstetric complications. DIC results in consumption of clotting factors and platelets, causing both microvascular thrombosis and paradoxical bleeding.
DIC occurs when excessive thrombin generation overwhelms the body's natural anticoagulant mechanisms, leading to widespread fibrin deposition in microvasculature. The massive consumption of coagulation factors, platelets, and fibrinogen depletes these essential components, while simultaneous activation of fibrinolysis creates fibrin degradation products that further impair hemostasis. This creates a vicious cycle of ongoing coagulation activation, consumption coagulopathy, and end-organ damage from microthrombosis.
Diagnosis requires integration of clinical presentation with laboratory findings including prolonged PT/PTT, decreased platelets and fibrinogen, elevated D-dimer, and presence of schistocytes on blood smear. Treatment focuses on addressing the underlying trigger while providing supportive care with blood products as needed, avoiding routine anticoagulation unless thrombosis predominates. The key is early recognition and aggressive management of the precipitating condition, as DIC mortality correlates directly with the severity of the underlying disease process.