Acquired Coagulation Defects: Disseminated Intravascular Coagulation

Description

General Measures

Medicine Treatment

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D65/D68.2/D68.8

DESCRIPTION

DIC is a complication of an underlying condition and is characterised by widespread activation of the clotting cascade which leads to consumption of clotting factors and platelets with generalized bleeding. No single diagnostic test, but the combination of a prolonged INR and PTT, presence of thrombocytopenia, decreased fibrinogen and increased D-dimer is highly suggestive of the diagnosis.

GENERAL MEASURES

• Identify and treat the underlying cause.
• If the patient is bleeding, replace haemostatic factors with cryoprecipitate or FFP/lyophilised plasma.
• If the patient is not actively bleeding and platelet count >20 x 10⁹ /L, then platelet transfusion is not necessary.

MEDICINE TREATMENT

For severe thrombocytopaenia (<20 x 10⁹ /L) and/or active bleeding:

• Platelet transfusion (apheresis single donor or pooled random donor), IV, 1 unit, immediately.
  • In chronic DIC, or in the absence of bleeding, platelet transfusions should not be given merely to correct the thrombocytopenia.

For hypofibrinogenaemia:

• Cryoprecipitate, IV, 1 unit/10 kg.

For depletion of other coagulation factors:

• Lyophilised plasma, IV, 15 mL/kg as initial dose.
  • Volume: ±200 mL/unit.

OR

• Fresh frozen plasma, IV, 15 mL/kg as initial dose.
  • Volume: ±280 mL/unit.

LoE:IIIb^xxv

• Repeat replacement therapy 8 hourly or less frequently, with adjustment according to the clinical picture and laboratory parameters.
• Monitor response with frequent estimation of the platelet count and coagulation screening tests.

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Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level_Version 1_30 March 2026

Chapter 2: Blood and Blood Forming Organs; 2.7 Acquired Coagulation Defects, 2.7.1 Disseminated Intravascular Coagulation (DIC)