Disseminated Intravascular Coagulation - Free Essay

Disseminated intravascular coagulation (DIC) is a rare and severe disorder with the potential for causing hemorrhage and thrombosis; also called consumption coagulopathy and defibrination syndrome, the condition causes proteins responsible for blood clotting to become overactive, resulting in abnormal blood clotting throughout the body's blood vessels (Boral et al., 2016). DIC can present as a chronic, subclinical process or an acute, life-threatening emergency, depending on the process's tempo and degree and the underlying causes contributing morbidities. Further comprehension of this condition underlines the need to discuss its causes, clinical manifestations, progression, predictive and protective factors, and their effects on an individual's health. Also, of importance is the current research on DIC, including gaps in evidence and the implications of research findings.

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Usually, when a person gets injured, blood proteins travel to the injury site to help thwart bleeding. However, as Boral et al. (2016) explain, if these proteins become overactive, they prompt DIC development. Normal hemostasis ensures a blood clot forms at the site of vessel injury, followed by clot resolution, allowing the tissues to repair themselves. In this system, there is multiple feedback meant to prevent coagulation activation whenever an individual is not injured, restricting clot formation at the injury site. In DIC, the coagulation and fibrinolysis processes become abnormally active in the vasculature and result in continued coagulation and fibrinolysis.

DIC is always secondary to an underlying disorder besides being linked to several conditions, most of which involve the activation of systemic inflammation. According to MedlinePlus (2020), DIC stems from another disease or condition, such as injury or infection, that prompts an overactive blood clotting process. More specifically, its causes include inflammation caused by a response to an illness, injury, or infection; severe tissue damage induced by trauma or burns; and clotting factors caused by pregnancy complications or cancers – pregnancy complications that produce clotting factors include amniotic fluid embolism and placental abruption.

The condition may develop more slowly or quickly over hours or days. The disease progression follows two stages, wherein during its early stages, overactive clotting results in blood clots' formation throughout blood vessels (MedlinePlus, 2020). These clots augment the likelihood of reduced or blocked blood flow, further leading to organ damage. DIC progression prompts the depletion of platelets and clotting factors, in turn, causing bleeding deep inside the body, in the mouth or nose, or just beneath the skin.

DIC presents as either acute or chronic. According to Mehta et al. (2015, p. 700), acute DIC develops when abrupt blood exposure to procoagulants prompts intravascular coagulation, quickly overwhelming compensatory hemostatic mechanisms, resulting in hemorrhage induced by severe consumptive coagulopathy. Conversely, chronic DIC reflects a compensated state that occurs due to blood's continuous or intermittent exposure to small tissue factor (TF) amounts (Mehta et al., 2015, p. 701). Unlike acute DIC, chronic DIC does not involve overwhelming compensatory mechanisms; hence, there may be diminutive noticeable clinical or lab signs.

Several risk factors augment an individual's danger of developing DIC. These include bacterial or fungal blood infection, cancer, especially certain leukemia types, massive hemangioma, liver disease, pancreatitis, pregnancy complications, reaction to blood transfusion, recent surgery or anesthesia, severe tissue injury, and lifestyle habits such as illegal drug use (MedlinePlus, 2020). These risk factors support the assertion that DIC is in itself not a specific disease; instead, it is an effect or complication of disease advance – always secondary to an underlying condition and is linked to several clinical conditions. Consequently, individuals who have these conditions are most likely to develop DIC.

There exists a plethora of research literature on DIC. Most of these studies have focused on the condition's pathogenesis, diagnosis, and the effectiveness of different treatment approaches (Papageorgiou et al., 2018). While studying these aspects, the authors highlighted several research gaps, including using DIC as an entry criterion in clinical trials. In this study, some of the identified treatment methods include activated protein C (APC), antithrombin (AT), thrombomodulin (TM), and tissue factor pathway inhibitor (TFPI) in patients with cancer, eclampsia-complicated pregnancy, sepsis, and trauma (Papageorgiou et al., 2018). The findings indicated APC effectiveness (lowering 28-day death) in severely septic patients and those with sepsis-associated DIC.

Nevertheless, this treatment method was ineffective in treating other patient groups (Papageorgiou et al., 2018). Due to this medication's role in augmenting the danger of bleeding in patients with sepsis, it was withdrawn from the market. Regarding the utilization of AT, the approach failed to demonstrate effectiveness in patients with severe sepsis, although further analysis hinted at possible efficacy in DIC patients (Papageorgiou et al., 2018). TM and TFPI have demonstrated promising outcomes in clinical trials.

Generally, this study's findings highlight several implications, in particular, the management of DIC. When treating this condition, clinicians usually incorporate different approaches depending on its symptoms and severity. Papageorgiou et al. (2018) contend that the primary treatment goals include controlling bleeding and clotting and treating the underlying cause (as the condition may disappear after treating the underlying cause). However, according to Boral et al. (2016), clinicians do not recommend treating DIC through prophylactical blood component transfusion, as this could augment the danger of "fueling the fire," especially in acute cases. Instead, this type of treatment is suitable for patients who face a high risk of bleeding complications, those who require a surgical procedure, or those experiencing hemorrhage. What this implies is that clinicians attending to DIC patients need to first understand the fundamental aspects of the condition before managing it.

Currently, most of DIC's therapeutic approaches are surprisingly not founded upon high evidence levels. For instance, according to Papageorgiou et al. (2018), most clinical trials have not objectively assessed other anticoagulants' efficacy and safety, clotting factor concentrates, or transfusion of platelet concentrates. Hence, this underlines the importance of promptly recognizing the condition and understanding its aspects to decide on an effective treatment approach. Given that either bleeding or no bleeding characterizes DIC, a clinician must consider whether to place the patient on medication or monitor blood tests, after which they may further treatment using blood product support.

Research by Papageorgiou et al. (2018) reflects a significant limitation in studies focused on understanding DIC. In particular, this limitation encompasses the inclusion of DIC diagnosis in the exclusion criteria for different studies. Including this criterion could significantly impact how clinicians understand the condition – including its pathophysiology and identification of novel treatment modalities, furthering day-to-day patient treatment.

Conclusion

In brief, DIC is a life-threatening condition that stems from severe coagulation system imbalance. Secondary to various clinical conditions, DIC may progress from asymptomatic to life-threatening. Drawing from these aspects, there is a need for clinicians and researchers to join forces to help manage the condition.

References

Boral, B. M., Williams, D. J., & Boral, L. I. (2016). Disseminated intravascular coagulation. American Journal of Clinical Pathology, 146(6), 670-680. https://doi.org.10.1093/AJCP/AQW195

Papageorgiou, C., Jourdi, G., Adjambri, E., Walborn, A., Patel, P., Fareed, J., Elalamy, I., Hoppensteadt, D., & Gerotziafas, G. T. (2018). Disseminated intravascular coagulation: an update on pathogenesis, diagnosis, and therapeutic strategies. Clinical and Applied Thrombosis/Hemostasis, 24(9), 8-28. https://doi.org/10.1177/1076029618806424

MedlinePlus (2020). Disseminated intravascular coagulation (DIC). U.S. Department of Health and Human Sciences. https://medlineplus.gov/ency/article/000573.htm

Mehta, Y., Sharma, J., & Gupta, M. (Eds.). (2015). Textbook of critical care: Two volume set. JP Medical Ltd.