The Intern At Work: Internal Medicine 148. In the Eye of the Storm - An Approach to Disseminated Intravascular Coagulation
May 29, 2022
Explore the complexities of disseminated intravascular coagulation (DIC) through an engaging analogy of a storm at sea. Discover the mechanisms and causes behind this condition, with a focus on the critical importance of accurate diagnosis. Learn key tips on diagnostic scoring and the potential pitfalls of normal fibrinogen levels. The discussion emphasizes tailored patient care and recent therapeutic advancements, making it a must-listen for anyone interested in internal medicine.
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DIC Is A Dual Threat
- DIC is a systemic, dysregulated activation of coagulation driven by tissue factor with simultaneous bleeding and thrombosis.
- Microvascular ischemia and hemorrhage both cause end-organ damage in DIC due to clot formation and factor consumption.
Always Hunt For The Trigger
- Always search for an underlying cause because DIC is secondary to another process like sepsis, malignancy, trauma, pancreatitis, or placental abruption.
- Identifying the trigger can uncover an otherwise occult illness and guides targeted treatment.
Tissue Factor Drives The Cascade
- Tissue factor release from monocytes and endothelium initiates the extrinsic pathway and drives thrombin generation in DIC.
- Endothelial activation and excess von Willebrand factor amplify platelet adhesion and coagulation.