What are the disease pathways that lead to the development of disseminated intravascular coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Several disease states may lead to the development of DIC (see Tables 1 and 2 below), generally via one of the following two pathways:

  • A systemic inflammatory response, leading to activation of the cytokine network and subsequent activation of coagulation (eg, in sepsis or major trauma)

  • Release or exposure of procoagulant material into the bloodstream (eg, in cancer, crush brain injury, or in obstetric cases)

In some situations (eg, major trauma or severe necrotizing pancreatitis), both pathways may be present.

Table 1. Causes of Acute (Hemorrhagic) Disseminated Intravascular Coagulation (Open Table in a new window)

Type

Cause

Infectious

Bacterial (eg, gram-negative sepsis, gram-positive infections, rickettsial)

Viral (eg, HIV, cytomegalovirus [CMV], varicella-zoster virus [VZV], and hepatitis virus)

Fungal (eg, Histoplasma)

Parasitic (eg, malaria)

Malignancy

Hematologic (eg, acute myelocytic leukemia)

Metastatic (eg, mucin-secreting adenocarcinoma)

Obstetric

Amniotic fluid embolism

Abruptio placentae

Acute peripartum hemorrhage

Preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome

Retained stillbirth

Septic abortion and intrauterine infection

Acute fatty liver of pregnancy [38]

Trauma

Burns

Motor vehicle accidents

Snake envenomation

Transfusion

Hemolytic reactions

Transfusion

Other

Liver disease/acute hepatic failure*

Prosthetic devices

Shunts (Denver or LeVeen)

Ventricular assist devices

*Some do not classify this as DIC; rather, it is liver disease with reduced blood coagulation factor synthesis and reduced clearance of activate products of coagulation.

 

Table 2. Causes of Chronic Disseminated Intravascular Coagulation (Open Table in a new window)

Type

Cause

Malignancies

Solid tumors

Leukemia

Obstetric

Retained dead fetus syndrome

Retained products of conception

Hematologic

Myeloproliferative syndromes

Vascular

Rheumatoid arthritis

Raynaud disease

Cardiovascular

Myocardial infarction

Inflammatory

Ulcerative colitis

Crohn disease

Sarcoidosis

Localized DIC

Aortic aneurysms

Giant hemangioma (Kasabach-Merritt syndrome)

Acute renal allograft rejection


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