Disseminated Intravascular Coagulopathy
James J. Corrigan Jr MD1
1 Professor of Pediatrics, Chief, Section of Pediatric Hematology-Oncology, University of Arizona, Health Sciences Center, Tucson, Arizona
Disseminated intravascular coagulation is most common in children with bacterial septic shock, infants with severe respiratory distress syndrome, in giant hemangiomas, and in purpura fulminans. The diagnosis is suspected when purpuric bleeding and/or thrombosis occurs in those clinical settings known to have DIC associated with them. The coagulopathy is also suspected when the patient has thrombocytopenia and prolonged clotting times in coagulation screening tests (prothrombin time and partial thromboplastin time). Confirmation of the diagnosis requires further laboratory data. Although it would be ideal to have a complete analysis of all the coagulation factors, this is generally not universally available nor always necessary in all cases. In the absence of liver disease, the minimal criteria for diagnosis is the combination of thrombocytopenia, positive fibrinolytic split products, and hypofibrinogenemia (or prolonged thrombin time). In the presence of liver disease, reduced factor VIII and/or the presence of circulating soluble fibrin complexes would be needed to diagnose DIC. Once the diagnosis is established and the underlying illness identified and treated, the therapy of the DIC is generally supportive. Anticoagulation (heparin) management is rarely needed except in cases of purpura fulminans, where it can be lifesaving, and selected cases of giant hemangioma or malignancy. In cases of septic shock and in severe RDS, successful management of the shock and the respiratory failure will cause the DIC to disappear without the use of anticoagulation.
