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Also known as: '''''DIC — Consumptive Coagulopathy'''''

| Also known as:

| '''DIC'''

==Description==

==Introduction==

 

DIC, also known as consumptive coagulopathy, is a condition where the coagulation and fibrinolytic cascades are out of control as a result of systemic [[Thrombosis|thrombosis]].  There is widespread clotting throughout the body with fibrinolysis and then a paradoxical [[Haemorrhage|haemorrhage]]. It is often recognised in dogs but rarely in cats.

DIC, also known as consumptive coagulopathy, is a condition where the coaguation and fibrinolytic cascades are out of control as a result of systemic [[Thrombosis|thrombosis]].  There is widespread clotting throughout the body with fibrinolysis and then a paradoxical [[Haemorrhage - Pathology|haemorrhage]]. It is often recognised in dogs but rarely in cats.

DIC always occurs as a secondary condition with an underlying cause.  

DIC always occurs secondary to another disease.

There are multiple aetiologies for DIC; once the cascade is under way the process is essentially the same.  Causes include:

There are multiple aetiologies for DIC, however, once the cascade is under way the disease process is essentially the same.  Causes include:

*Sepsis, particularly gram negative organisms.

*Sepsis, particularly gram negative organisms.

*Obstetric complications; chemicals released from the uterus.

*Obstetric complications; chemicals released from the uterus.

*Tissue trauma E.g. burns.

*Tissue trauma e.g. burns.

*Liver disease.

*Liver disease.

*Transfusion reaction.

*[[Administering_a_Blood_Transfusion#Adverse_Reactions|Transfusion reactions]].

*Neoplasia.

*Neoplasia.

*Certain snake venoms.

*Certain snake venoms.

Once coagulation begins a positive feedback loop is set up whereby coagulation inhibitors are consumed, allowing more coagulation. In this way coagulation continues and induces further coagulation.   

Once [[Normal_Mechanisms_of_Haemostatic_Control#Coagulation_physiology|coagulation]] begins a positive feedback loop is set up whereby coagulation inhibitors are consumed, allowing more coagulation. In this way coagulation continues and induces further coagulation.   

Thrombin levels are increased.  Thrombin converts plasminogen into the active form, plasmin and initiates the fibrinolytic cascade. Fibrinolysis produces high levels of FDPs (fibrin degradation products) which are themselves anticoagulants, further fuelling the coagulation cascade.

Thrombin levels rise; thrombin converts plasminogen into the active form, plasmin which initiates the fibrinolytic cascade. Fibrinolysis produces high levels of fibrin degradation products (FDPs) which are themselves anticoagulants, promoting further lysis. As thrombi form in the vasculature, tissues become hypoxic leading to multisystemic organ failure in severe cases.   

As thrombi form in the vasculature tissues will become hypoxic leading to multisystemic organ failure in severe cases.   

As [[Thrombocytes|platelets]] are used up in the thrombi a [[Platelet Abnormalities#Thrombocytopaenia|thrombocytopaenia]] occurs, leading to a paradoxical haemorrhage and the patient starts to bleed.  This is the mechanism by which most viral haemorrahgic diseases cause their clinical signs.

As [[Thrombocytes|platelets]] are used up in the thrombi, a [[Platelet Abnormalities#Thrombocytopaenia|thrombocytopaenia]] occurs which leads to paradoxical haemorrhaging and the patient starts to shown symptoms of bleeding.  This is the mechanism by which most viral haemorrahgic diseases induce clinical symptoms.

==Clinical Symptoms==

 

These are noted due to spontaneous primary bleeding, including petechiae, ecchymoses, mucosal bleeding or secondary bleeding into body cavities e.g. [[Haemoabdomen|haemoabdomen]].

==Clinical Signs==

[[:Category:Altered Ventricular Impulse Formations|Ventricular arrythmias]] may also be present due to myocardial hypoxia or thrombosis.

Present due to spontaneous primary bleeding and include Petechiae, ecchymoses, mucosal bleeding or secondary bleeding into body cavities e.g [[Haemoabdomen|haemoabdomen]].

Ventricular arrythmias may also be present due to myocardial hypoxia or thrombosis.

==Laboratory Tests==

==Laboratory Tests==

===Blood Smear===

===Blood Smear===

Will see evidence of anaemia which can be regenerative or non-regenerative depending on the underlying cause of DIC.

Will see evidence of [[Regenerative and Non-Regenerative Anaemias|anaemia]] which can be regenerative or non-regenerative depending on the underlying cause of DIC.

Also a neutrophilia with a left shift and thrombocytopaenia will be present. Schistocytes may also be seen due to haemolysis.

Also a [[Neutrophilia|neutrophilia]] with a left shift and thrombocytopaenia will be present. Schistocytes may also be seen due to haemolysis.

===Biochemistry===

===Biochemistry===

Can reveal an azotaemia and hyperphosphataemia, increased liver enzyme activity and if severe enough a hypoproteinaemia.

Can reveal an [[Azotaemia|azotaemia]] and hyperphosphataemia, increased [[Liver - Anatomy & Physiology|liver]] enzyme activity and if severe enough a hypoproteinaemia.

===Haematology===

===Haematology===

Will reveal a decreased PCV, a thrombocytopaenia and often a neutrophiia with a left shift.

Will reveal a decreased PCV, a thrombocytopaenia and often a neutrophilia with a left shift.

===Urinalysis===

===Urinalysis===

==Treatment==

==Treatment==

It is important to identify and treat the underlying cause of the DIC.  

It is important to identify and treat the underlying cause of the DIC.  

It is also important to ensure adequate tissue perfusion and support target organs susceptible to ischaemia and haemorrhage by fluid therapy.   

It is also important to ensure adequate tissue perfusion and support target organs susceptible to [[Ischaemia|ischaemia]] and haemorrhage by [[Principles of Fluid Therapy|fluid therapy]].   

Anticoagulants should be used with caution as the patient will be prone to haemorrhage and blood components must be replaced via transfusion with fresh frozen plasma to provide clotting factors and platelets.

Anticoagulants should be used with caution as the patient will be prone to haemorrhage and blood components must be replaced via [[:Category:Transfusion Medicine|transfusion]] with fresh frozen [[Plasma|plasma]] to provide clotting factors and platelets.

==Prognosis==

==Prognosis==

DIC has a poor prognosis with a high mortality rate.

DIC has a poor prognosis with a high mortality rate.

[[Category:Cardiovascular_System_-_Vascular_Pathology]][[Category:Cardiovascular_System_-_Inflammatory_Pathology]][[Category:Arterial_Pathology]]

[[Category:Cardiovascular_System_-_Vascular_Pathology]][[Category:Cardiovascular_System_-_Inflammatory_Pathology]][[Category:Arterial_Pathology]]

[[Category:To_Do_-_Cardiovascular]][[Category:To Do - Caz]]

[[Category:Coagulation Defects]][[Category:Vascular Diseases - Dog]][[Category:Lymphoreticular and Haematopoietic Diseases - Dog]][[Category:Vascular Diseases - Cat]]

[[Category:Cardiology Section]]