Acute Promyelocytic Leukemia (APML) (see Acute Promyelocytic Leukemia, [[Acute Promyelocytic Leukemia]]): patient may present with DIC acutely or after initiation of chemotherapy
Brain Tumors
NK Cell Leukemia (aka Aggressive NK Cell Leukemia, ANKL) (see NK Cell Leukemia, [[NK Cell Leukemia]])
Mucinous Tumors
Breast Cancer (see Breast Cancer, [[Breast Cancer]])
Rattlesnake Bite (see Rattlesnake Bite, [[Rattlesnake Bite]]): however, some consider this to be a coagulopathy/thrombotic microangiopathy that is distinct from DIC
Cardiopulmonary Bypass (CPB) (see Cardiopulmonary Bypass, [[Cardiopulmonary Bypass]]): the diagnosis of DIC post-cardiopulmonary bypass is difficult (since the identification of microthrombi is difficult and hemolysis and consumption of coagulation factors may be commonly seen following cardiopulmonary bypass)
Hemorrhage: common in acute DIC (less common in chronic DIC) -> occurs in 64% of acute DIC cases
Hemorrhage from Wound/Trauma/Catheter/Drain Sites
Diffuse Alveolar Hemorrhage (DAH) (see Diffuse Alveolar Hemorrhage, [[Diffuse Alveolar Hemorrhage]]): due to damage to the pulmonary vascular endothelium
Hemodynamic Support (Pressors, Intravenous Fluids): as required
Mechanical Ventilation: as required
Treatment of Thrombotic Complications
Anticoagulation: as required to treat thrombotic complications
Treatment of Bleeding Complications
Antifibrinolytic Agents (Tranexamic Acid, Epsilon-Aminocaproic Acid, Aprotinin): contraindicated (since blockade of the fibrinolytic system may increase the risk of thrombosis)
However, these agents may be used in patients who have severe bleeding associated with a hyperfibrinolytic state
Antithombin: trials have shown this to be ineffective in DIC
One unit of cryoprecipitate (10-20 ml) contains the cold insoluble protein from one unit of FFP (contains vWF, factor VIII, factor XIII, fibrinogen, and fibrinonectin)
Some blood suppliers now provide one bag of pre-pooled cryoprecipitate which contains 5 (or more) units in 120-160 mL: use two bags of pre-pooled cryoprecipitate (ie: from 10 units of FFP)
Fresh Frozen Plasma (FFP) (see Fresh Frozen Plasma, [[Fresh Frozen Plasma]]): as required to treat coagulopathy in the setting of significant hemorrhage or need for invasive procedures
Packed Red Blood Cells (see Packed Red Blood Cells, [[Packed Red Blood Cells]]): as required to treat hemorrhage-related anemia
Transfuse for Platelet Count <50k: in the setting of significant hemorrhage or need for invasive procedures
Transfuse for Platelet Count <10k: in all patients (due to the risk of spontaneous hemorrhage)
Prothrombin Complex Concentrates: likely contraindicated (due to risk of more thrombotic complications in the setting of an already hypercoagulable state)
Treatment of Purpura Fulminans (see Purpura Fulminans, [[Purpura Fulminans]])
Fresh Frozen Plasma (FFP) (see Fresh Frozen Plasma, [[Fresh Frozen Plasma]]): the administration of FFP as a source of protein C is problematic because of the short plasma half-life of protein C
Due to short plasma protein C half-life, FFP 2-3 units may be administered approximately every 6 hrs
Protein C Concentrate (see Protein C Concentrate, [[Protein C Concentrate]]): proven to decrease mortality rate in purpura fulminans
Expected Course of Resolution
Factors Impacting the Rate of DIC Resolution: DIC does not usually resolve immediately once the inciting factor is corrected
Resolution requires the synthesis of coagulant factors (which are synthesized at different rates)
Resolution requires hepatic clearance of anticoagulant factors and fibrin degradation products
Resolution requires bone marrow production of new platelets (which may take several days)
Resolution of DIC-Related Laboratory abnormalities: usually improve within a few days after the inciting stimulus is removed
Impact of Renal Failure on the Rate of DIC Resolution: does not impact the rate DIC resolution (unless there is a component of hepatorenal syndrome or if the kidneys are a major site of thrombosis)