Transfusion medicine handbook

6. Special Circumstances

6.12 Disseminated Intravascular Coagulation (DIC)

In this syndrome there is generation of thrombin leading to consumption of circulating coagulation factors and platelets with subsequent fibrin deposition. Ischaemic organ damage particularly in the renal circulation can occur due to microthrombi. The treatment of DIC involves supportive care while treating the underlying primary condition. In the presence of active bleeding, or where there is a high risk of major bleeding such as prior to some invasive procedures, transfusion support to replace coagulation factors and platelets is likely to be appropriate.

If the patient is bleeding and there is a low risk of circulatory overload then FFP is optimal as it contains a full spectrum of coagulation factors. Prothrombinex-VF is contraindicated in the presence of DIC.

For bleeding patients with severe hypofibrinogenaemia despite FFP replacement, cryoprecipitate should be infused keeping the fibrinogen level > 1.5 g/L. Antithrombin concentrates may be considered where DIC is secondary to sepsis or in cases of thrombosis-predominant DIC treated with therapeutic dose heparin. A platelet count of 10 - 20 x 10⁹/L can usually be tolerated in the absence of bleeding while transfusion is recommended with a platelet count < 50 x 10⁹/L in the presence of active bleeding or prior to invasive procedures. For epidural or intrathecal procedures  a higher platelet is likely to be desirable.

The management of DIC requires careful coordination between the treating clinician and NZBS to ensure adequate supplies of blood components and plasma products are available and that these are used based upon relevant coagulation tests.