Overview

To understand DIC, it helps to understand the body's normal blood clotting process. Your body has a system to control bleeding. When small cuts or breaks occur on blood vessel walls, your body activates clotting factors. These clotting factors, such as thrombin and fibrin, work with platelets to form blood clots.

Blood clots seal the small cuts or breaks on the blood vessel walls. After bleeding stops and the vessels heal, your body breaks down and removes the clots.

Some diseases and conditions can cause clotting factors to become overactive, leading to DIC. These diseases and conditions include:

• Sepsis (an infection in the bloodstream)
• Surgery and trauma
• Cancer
• Serious complications of pregnancy and childbirth

Examples of less common causes of DIC are bites from poisonous snakes (such as rattlesnakes and other vipers), frostbite, and burns.

The two types of DIC are acute and chronic. Acute DIC develops quickly (over hours or days) and must be treated right away. The condition begins with excessive blood clotting in the small blood vessels and quickly leads to serious bleeding.

Chronic DIC develops slowly (over weeks or months). It lasts longer and usually isn't recognized as quickly as acute DIC. Chronic DIC causes excessive blood clotting, but it usually doesn't lead to bleeding. Cancer is the most common cause of chronic DIC.

Treatment for DIC involves treating the clotting and bleeding problems and the underlying cause of the condition.

People who have acute DIC may need blood transfusions, medicines, and other life-saving measures. People who have chronic DIC may need medicines to help prevent blood clots from forming in their small blood vessels.

Outlook

The outlook for DIC depends on its severity and underlying cause. Acute DIC can damage the body's organs and even cause death if it's not treated right away. Chronic DIC also can damage the body's organs.

Researchers are looking for ways to prevent DIC or diagnose it early. They're also studying the use of various clotting proteins and medicines to treat the condition.

DIC is caused by another medical condition that makes the body’s normal blood clotting process become overactive. The condition progresses through two stages. In the early stages, overactive clotting leads to blood clots throughout the blood vessels. The clots can reduce or block blood flow, damaging organs.

As DIC progresses, the overactive clotting uses up platelets and clotting factors, which are proteins that help with normal blood clotting. Without these platelets and clotting factors, DIC can cause bleeding just beneath the skin, in the nose or mouth, or deep inside the body.

Causes of DIC include:

• Inflammation in response to infection, injury, or an illness
• Severe tissue damage, such as from burns or trauma
• Clotting factors caused by some cancers or pregnancy complications. Pregnancy complications that produce clotting factors include placental abruption, in which the placenta separates from the uterus, and amniotic fluid embolism, in which amniotic fluid that surrounds the unborn baby enters the mother’s bloodstream.

To understand DIC, it helps to understand the body’s normal blood clotting process. Blood clots form naturally at sites of injury to prevent or control bleeding. When small cuts or breaks occur on the walls of the blood vessels, your body turns on clotting factors. The clotting factor thrombin forms long fibrin protein strands that clump together with platelets to create blood clots that then seal the cuts or breaks. Once bleeding stops, the body begins breaking down the clots as part of the blood vessel healing process.

Risk factors for DIC include infection, injury, lifestyle habits, and other medical conditions.

Infection

Sepsis, a body-wide response to infection that causes inflammation, is the most common risk factor for DIC. The infection may be caused by parasites, bacteria, fungi, or viruses.

Injury

Major damage to organs or tissues can raise your risk of DIC. Examples include cirrhosis, pancreatitis, severe trauma or injury, burns, or major surgery.

Lifestyle habits

Use of illegal drugs, such as cocaine and ecstasy, may increase the risk of DIC.

Other medical conditions

Medical conditions that may raise your risk of DIC include:

• Blood vessel abnormalities, including aortic aneurysms and large hemangiomas, which are growths of tangled blood vessels
• Cancer, including cancers affecting the pancreas, stomach, colon, or blood
• Heat stroke
• Pregnancy complications, such as when the placenta separates from the uterus before delivery, when amniotic fluid enters the bloodstream, or when there is serious bleeding during or after delivery
• Severe immune reactions, which may occur with an incompatible blood transfusion, rejection of an organ transplant, or atoxin such as snake venom

Routine screening is not performed for DIC. If you have a medical condition that raises your risk for DIC, your doctor may recommend testing. For more information about medical tests, visit the Diagnosis section.

Prevention

DIC can result from many medical conditions, most of which cannot be prevented. Sometimes, immediate or prompt treatment after a procedure or medical condition may help prevent DIC.

Signs and symptoms of DIC depend on whether the condition is acute or chronic. Acute DIC is more severe and develops quickly over hours or days. The first sign may be bleeding. Chronic DIC, such as from cancer, happens more slowly and sometimes has no signs or symptoms.

Complications from DIC can occur from both the clotting that happens in the early stages of the condition and from bleeding in the later stages. Serious complications include organ damage and hemorrhage.

Signs and symptoms

Signs and symptoms of DIC may include:

• Bruising, which may appear easily, and often in various areas as small dots or larger patches
• Bleeding at the site of wounds from surgical cuts or from placement of a needle
• Bleeding from the nose, gums, or mouth, including when you brush your teeth
• Blood in the stools from bleeding in the intestines or stomach. Stools may appear dark red or like tar.
• Blood in the urine
• Chest pain, trouble breathing, and shortness of breath
• Confusion, speech changes or trouble speaking, dizziness, or seizures
• Headaches
• Low blood pressure
• Pain, redness, warmth, and swelling in the lower leg
• Unusually heavy periods

Complications

DIC can lead to complications resulting from overactive clotting or from the bleeding that follows. These complications can be life-threatening and may include:

• Acute respiratory distress syndrome (ARDS)
• Bleeding from the gastrointestinal tract (GI tract) or elsewhere in the body if you have acute DIC. This is not common in chronic DIC, since clotting develops more slowly, and your body can make enough platelets and clotting factors.
• Heart attack, if a blood clot blocks or limits blood flow to your heart
• Multiple organ failure, if blood clots prevent oxygen from reaching your organs. These organs can include the lungs and kidneys, followed by the brain, heart, liver, spleen, adrenal glands, pancreas, and the GI tract.
• Shock
• Stroke, if a blood clot blocks or limits blood flow to your brain, or if there is bleeding in the brain
• Venous thromboembolism (VTE), which can include blood clots in the lungs, called pulmonary embolism, or in the deep veins of the legs, called deep vein thrombosis

Your doctor will diagnose DIC based on your medical history, a physical exam, and tests. Your doctor will also look for the cause of DIC, because it does not occur on its own.

Medical history and physical exam

To help diagnose DIC, your doctor will ask about any medical conditions or recent events, such as illness or an injury, that could cause or be a risk factor for DIC. Your doctor will do a physical exam to look for signs and symptoms of blood clots, bleeding, or a condition that could cause DIC or a complication of DIC.

Diagnostic tests

If your doctor suspects DIC, the following blood tests may help diagnose it:

• Blood clotting tests, such as prothrombin time (PT) and partial thromboplastin time (PTT), to measure how well and how long it takes your blood to clot. If you have DIC, your clotting time may be longer than normal.
• Complete blood count (CBC) to measure the number of red blood cells, white blood cells, and platelets in your blood. If you have DIC, the numbers of platelets, red cells, or both may be low.
• Comprehensive metabolic panel (CMP) to measure your kidney function, liver function, and the sugar and electrolyte levels in your blood. Abnormal results could indicate that DIC caused damage to your kidneys or liver or could identify another underlying condition that caused your DIC.
• D-dimer tests to look for blood clots. The test measures D-dimer, a substance that is released in the blood when blood clots dissolve. D-dimer levels may be high if you have DIC.
• Peripheral blood smear to look at the number, size, and shape of your platelets and other blood cells. In a peripheral blood smear, a small amount of your blood is examined under a microscope. The presence of damaged red blood cells may suggest DIC.
• Serum fibrinogen tests to measure how much fibrinogen is in your blood. Fibrinogen is a protein that helps the blood clot and may be low if you have DIC.

Your doctor may use a scoring system to diagnose DIC. The score is based on your platelet count, PT, D-dimer test, and fibrinogen levels. The higher the score, the more likely it is that you have DIC. To make a diagnosis, your doctor may repeat some tests and monitor your condition over time.

Tests for other medical conditions

Your doctor may suggest additional tests or procedures to find out whether another condition is causing your symptoms. These tests may include:

• ADAMTS13 testing to check blood levels and activity of this protein, which is low in thrombotic thrombocytopenic purpura (TTP), a type of platelet disorder
• Liver biopsy and liver function tests to check for cirrhosis or chronic liver disease, which may have signs and symptoms that are similar to DIC

Treatment for DIC depends on its severity and symptoms. The main goals of treatment for DIC are to control clotting and bleeding and to treat the underlying cause. DIC may go away once the underlying cause is treated.

Medicines

Your doctor may use anticoagulants, also called blood thinners, to reduce blood clotting. You may be given them as a pill, as an injection, or through an IV. Possible side effects include bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.

Procedures and therapies

Your doctor may recommend the following treatments.

• Clotting factor replacement such as fibrinogen. This is used to stop bleeding.
• Oxygen therapy to allow more oxygen to reach the lungs, the heart, and the rest of the body if blood clots are preventing oxygen from reaching your organs.
• Plasma transfusion, which provides clotting factors,to stop or prevent bleeding.
• Platelet transfusion to quickly raise platelet levels to stop or prevent bleeding.

Acute DIC and its underlying causes are serious life-threatening conditions, so your treatment management and recovery will likely be done in the hospital. If you have been diagnosed with DIC, it is important that you follow your treatment plan, get regular care, and learn the warning signs of complications.

Receive routine follow-up care

Your follow-up care may include recommendations such as the following.

• Take all medicines regularly, as your doctor prescribes. Do not change the amount of your medicine or skip a dose unless your doctor tells you to.
• Follow all treatments and testing for the medical condition that caused your DIC.
• Talk with your doctor about how often you should schedule office visits and blood tests.
• Call your doctor if you have any new symptoms or if your symptoms worsen.

Monitor your condition and prevent complications

You may need to take blood-thinning medicines to help prevent blood clots or to keep existing clots from getting larger. If you are taking blood thinners, talk to your doctor about how often you should schedule follow-up visits. Your doctor may recommend regular blood tests to check how well your blood is clotting.

Also, let everyone on your healthcare team know you are taking blood-thinning medicines. If you need surgery, your doctor may adjust the amount of medicine you take before, during, and after the surgery to prevent bleeding. This also may happen before dental work, but it is less common.

Learn the warning signs of serious complications and have a plan

DIC can lead to serious complications such as heart attack or stroke. Risks of treatment with blood thinners include severe bleeding in the brain.

If you think that you or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.

Bleeding

If youtake a dose of blood-thinning medicine that is too high, it may cause bleeding in the digestive system or in the brain.Signs and symptoms include severe pain in your head, sudden changes in your vision, sudden inability to move your legs or arms, memory loss or confusion, bright red vomit or vomit that looks like coffee grounds, blood in your urine or stool, or black, tarry stools.

A lot of bleeding after a fall or injury, or easy bruising or bleeding, may mean that your blood is too thin. Excessive bleeding is bleeding that will not stop after you apply pressure to a wound for 10 minutes. Call your doctor right away if you have any of these signs.

Heart attack

Heart attack symptoms include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. This discomfort can feel like pressure, squeezing, fullness, heartburn, or indigestion. There also may be pain down the left arm. Although men and women can experience these symptoms, women are more likely to have other, less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw.

Stroke

If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.

F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.

Learn about other precautions to help you stay safe

Talk with your doctor before using any over-the-counter medicines or products, including vitamins, supplements, or herbal remedies. Some of these products can affect blood clotting and bleeding. For example, aspirin and ibuprofen may thin your blood too much. This can increase your risk of bleeding. Vitamin K supplements can prevent certain blood thinners from working.