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You are here: Cancer information / Diagnosis and treatment / Managing side effects / Disseminated intravascular coagulation

Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DIC) is a condition that begins with blood clots developing in the bloodstream. The clots can block small blood vessels in the extremities (deep vein thrombosis) or organs. Blood clotting is triggered by substances released into the blood. Platelets and other blood clotting factors – which are needed to control bleeding – eventually become depleted and excessive bleeding (hemorrhage) can occur.

Causes

DIC may be brought on by:

  • cancer
    • leukemia, especially acute leukemia
      • most commonly in acute promyelocytic leukemia (APL)
    • some solid tumour cancers, particularly adenocarcinomas
      • most commonly in breast, prostate, lung, stomach or pancreatic cancer
  • infection in the blood (sepsis)
  • reaction to a blood transfusion
  • severe liver disease or liver metastases
  • recent surgery or anesthesia

Symptoms

DIC may appear suddenly and can be severe. Symptoms of DIC may include:

  • excessive blood clotting
  • fever
  • low blood pressure
  • low blood oxygen levels (hypoxia)
  • excessive bleeding and bruising
    • bleeding may occur at an intravenous site, in the brain, skin, muscles, digestive tract or abdominal cavity

Diagnosis

Tests that help diagnose DIC include:

  • blood tests to measure blood clotting-related factors (coagulation studies)
    • complete blood count (CBC) – to measure the number of platelets
    • prothrombin time (PT) – to measure how long it takes blood to clot
    • plasma fibrinogen level – to measure the amount of protein (fibrinogen) in the blood, which is necessary for blood to clot
  • a blood test to measure the amount of proteins produced when clots are broken up by the body (fibrin degradation products or FDP)

Treatment

  • The underlying cause of DIC needs to be identified and treated. If an infection is the main cause of DIC, antibiotic therapy is given. If DIC is caused by cancer, anticancer treatment is given. DIC that develops suddenly can be life-threatening.

 

Supportive measures for DIC include:

  • transfusion of blood products such as platelets, red blood cells, fresh frozen plasma or other clotting factors – to stop bleeding and replace diminished blood components
  • oxygen therapy – to treat low blood oxygen levels
  • intravenous fluids – to replace fluids lost because of severe bleeding
  • medication (heparin) – to slow or stop the clotting process
  • medications (fibrinolytic inhibitors) – may be used to prevent the breakdown of clots and control bleeding:
    • epsilon-amino-caproic acid (EACA, Amicar)
    • tranexamic acid (retinoic acid) – used to treat acute promyelocytic leukemia when there is a high risk of DIC occurring

References

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