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Disseminated Intravascular Coagulation (DIC)

Disseminated Intravascular Coagulation (DIC) is a life-threatening acquired coagulation disorder characterized by widespread activation of the clotting system. This causes formation of microthrombi, consumption of platelets and clotting factors, and can result in both thrombosis and severe bleeding

Also called

Consumptive Coagulopathy

ICD-10

D65

Specialty

Hematology

Onset

Acute

Reviewed

August 2026

On This Page

Overview

Disseminated Intravascular Coagulation (DIC) occurs when an underlying condition causes excessive activation of coagulation throughout the circulation. Widespread microvascular thrombosis consumes platelets and clotting factors, while increased fibrinolysis contributes to bleeding. It is usually secondary to conditions such as sepsis, trauma, malignancy, and obstetric emergencies

Etiology & Risk Factors

-Etiology

Disseminated Intravascular Coagulation (DIC) is always associated with an underlying condition that activates systemic coagulation.

-Common Causes

Severe Infection

  • Sepsis

  • Severe bacterial infection

  • Severe viral infection

  • Severe fungal infection

Obstetric Conditions

  • Placental abruption

  • Amniotic fluid embolism

  • Retained dead fetus

  • Severe postpartum hemorrhage

  • Severe preeclampsia/HELLP syndrome

Malignancy

  • Acute Promyelocytic Leukemia

  • Advanced solid tumors

Major Tissue Injury

  • Major trauma

  • Burns

  • Major surgery

  • Severe pancreatitis

  • Shock

Other Causes

  • Snake envenomation

  • Severe transfusion reactions

  • Vascular abnormalities

Pathophysiology

Underlying disease → widespread activation of coagulation → excessive thrombin generation → fibrin deposition and microthrombus formation → consumption of platelets and clotting factors → secondary activation of fibrinolysis → breakdown of fibrin and increased fibrin degradation products → bleeding tendency → simultaneous microvascular thrombosis → tissue ischemia and organ dysfunction

Clinical Presentation

Symptoms

  • Bleeding

  • Bruising

  • Fatigue

  • Shortness of breath

  • Chest pain

  • Abdominal pain

  • Headache

  • Reduced urine output

Signs

  • Petechiae

  • Ecchymoses

  • Oozing from IV or injection sites

  • Mucosal bleeding

  • Gastrointestinal bleeding

  • Hematuria

  • Vaginal bleeding

  • Signs of organ dysfunction

  • Signs of thrombosis

History Taking

-Ask about:

  • Active bleeding
  • Easy bruising
  • Hematuria
  • Melena
  • Hematemesis
  • Vaginal bleeding
  • Recent trauma
  • Recent surgery
  • Infection or sepsis
  • Pregnancy or recent delivery
  • Known malignancy
  • Recent transfusion
  • Medication history
  • Snake bite or toxin exposure

Physical Examination

-General Examination

Look for:

  • Pallor

  • Fever

  • Tachycardia

  • Hypotension

  • Signs of shock

-Skin Examination

Assess for:

  • Petechiae

  • Purpura

  • Ecchymoses

  • Skin ischemia

  • Peripheral cyanosis

-Bleeding Sites

Look for:

  • Mucosal bleeding

  • IV-site bleeding

  • Gastrointestinal bleeding

  • Genitourinary bleeding

-Systemic Examination

Assess for organ dysfunction:

  • Neurological abnormalities

  • Renal impairment

  • Respiratory distress

  • Hepatic dysfunction

  • Cardiac ischemia

Investigations

-Complete Blood Count

Typical findings:

  • Thrombocytopenia

  • Anemia may occur due to bleeding or hemolysis

Peripheral Blood Film

May show:

  • Schistocytes

  • Polychromasia

  • Thrombocytopenia

-Coagulation Profile

Typical findings:

  • ↑ PT

  • ↑ aPTT

  • ↓ Fibrinogen

  • ↑ D-dimer

  • ↑ Fibrin degradation products

-D-Dimer

  • Usually markedly elevated : This reflects increased formation and breakdown of fibrin.

-Fibrinogen

  • Usually decreased in rapidly evolving DIC

  • May be normal or elevated in slower/chronic DIC because fibrinogen is also an acute-phase reactant

-Renal Function

Check:

  • Urea

  • Creatinine

  • Electrolytes

  • Urinalysis

-Liver Function

Assess for:

  • Hepatic injury

  • Alternative causes of abnormal coagulation

Diagnosis

Diagnosis is based on:

  • Appropriate underlying clinical condition
  • Thrombocytopenia
  • Prolonged PT
  • Prolonged aPTT
  • Elevated D-dimer
  • Reduced or falling fibrinogen
  • Schistocytes in some patients
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Management

1. Treat the Underlying Cause

This is the most important treatment.

Examples:

  • Sepsis → appropriate antibiotics + source control

  • Placental abruption → urgent obstetric management

  • Acute Promyelocytic Leukemia → immediate disease-specific treatment

  • Trauma → hemorrhage control and resuscitation

  • Malignancy → appropriate cancer treatment

2. Supportive Blood Product Therapy

Platelets

Consider when:

  • Significant bleeding with severe thrombocytopenia

  • High-risk invasive procedure

Fresh Frozen Plasma

Consider when:

  • Active bleeding

  • Significant prolongation of PT/aPTT

  • Multiple clotting factor deficiencies

Cryoprecipitate / Fibrinogen Replacement

Consider when:

  • Significant bleeding

  • Severe hypofibrinogenemia

3. Red Blood Cells

  • Transfuse when clinically significant anemia or hemorrhage is present.

4. Anticoagulation

Anticoagulation may be considered when thrombosis predominates, such as:

  • Venous thromboembolism

  • Extensive thrombosis

  • Chronic thrombotic Disseminated Intravascular Coagulation (DIC)

Routine anticoagulation is generally not used in actively bleeding patients

Complications

  • Severe bleeding
  • Intracranial hemorrhage
  • Gastrointestinal hemorrhage
  • Acute kidney injury
  • Respiratory failure
  • Hepatic dysfunction
  • Stroke
  • Myocardial ischemia
  • Peripheral ischemia
  • Multiorgan failure
  • Death

Prognosis

The prognosis depends primarily on the underlying cause and severity of Disseminated Intravascular Coagulation (DIC). Rapid recognition and treatment of the underlying disorder can reverse the coagulation abnormalities. Severe or uncontrolled Disseminated Intravascular Coagulation (DIC) can lead to major bleeding, thrombosis, multiorgan failure, and death.

Key Points / Clinical Pearls

  • Disseminated Intravascular Coagulation (DIC) is an acquired systemic coagulation disorder.
  • It causes both microvascular thrombosis and consumption of clotting factors.
  • Common causes include sepsis, trauma, malignancy, and obstetric emergencies.
  • Typical findings: ↓ platelets, ↑ PT/aPTT, ↑ D-dimer, ↓ fibrinogen.
  • Schistocytes may be present.
  • Severe Disseminated Intravascular Coagulation (DIC) can cause simultaneous bleeding and thrombosis.
  • Treat the underlying cause first.
  • Platelets, plasma, and fibrinogen replacement are used selectively according to clinical bleeding and laboratory abnormalities.
  • Anticoagulation is reserved for selected patients in whom thrombosis predominates.
  • Severe Disseminated Intravascular Coagulation (DIC) can cause multiorgan failure and death.
  • Costello RA, Leslie SW, Nehring SM. National Center for Biotechnology Information (NIH). Disseminated Intravascular Coagulation, StatPearls .
  • Iba T, Levy JH, Maier CL, et al. Updated definition and scoring of disseminated intravascular coagulation in 2025: communication from the ISTH SSC Subcommittee on Disseminated Intravascular Coagulation. J Thromb Haemost. 2025;23:2356-2362. Journal of Thrombosis and Haemostasis .
  • Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol. 2009;145(1):24-33.
  • Wada H, Thachil J, Di Nisio M, et al. Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013;11(4):761-767.
  • Umemura Y, Scarlatescu E, Nwagha TU, et al. Mortality, diagnosis, and etiology of disseminated intravascular coagulation— a systematic review and meta-analysis: communication from the ISTH SSC Subcommittee on Disseminated Intravascular Coagulation. J Thromb Haemost. 2025;23(8):2663-2679. Journal of Thrombosis and Haemostasis .