Disseminated Intravascular Coagulation (DIC)
Disseminated intravascular coagulation, or DIC, is a complicated condition that can occur when someone has severe sepsis or septic shock. Both blood clotting and difficulty with clotting may occur, causing a vicious cycle. Small blood clots can develop throughout your bloodstream, especially in the microscopic blood vessels called capillaries, blocking the blood flow to many parts of your body, including your limbs and your organs. This blood flow is needed to bring oxygen and nutrients to the tissues. On the reverse side of the cycle, DIC can cause increased bleeding because the body is using up so many of the blood clotting proteins for the multiple blood clots in the blood vessels that there are not enough of them left to clot the blood elsewhere.
There are several medical conditions that can cause DIC, including sepsis. DIC affects about 35% of patients who have sepsis. Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection. Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.
Symptoms of DIC
- Blood clots
- Bruising, mottling of the skin
- Drop in blood pressure
- Bleeding, from many sites in the body
Treatment of DIC
When someone has DIC caused by sepsis, the primary task is to treat the sepsis and the infection that caused it. In addition to treating sepsis, the clots may have to be dissolved and new clots prevented. This may be done with heparin, an anticoagulant, often called a blood thinner. When someone is receiving heparin, their blood is tested regularly for its ability to clot – whether it is clotting too quickly or not quickly enough – so the heparin dose can be adjusted as needed.
A transfusion of platelets may be necessary. Platelets are a component of your blood that helps form clots.
Complications from DIC
If clots prevent blood from reaching parts of the body, tissue damage occurs. For example, if clots prevent blood from circulating properly to the hands or feet, the tissue may start to turn splotchy, then bluish in color (cyanotic), and then black (gangrenous) if the skin dies. Once the tissue has reached this stage, it must be removed. For some people, this may be a small patch of skin or a few fingers or toes, but for others, it could mean amputation of one or more limbs.
If blood isn’t effectively reaching vital organs like your kidneys, liver, or lungs, they may have trouble functioning. For example, if your kidneys are affected, they may not be able to effectively filter urine, making dialysis necessary. If the kidneys regain function, dialysis may not be needed over the long-term. Or if you are having difficulty breathing because of DIC, the doctors may choose to place you on a ventilator, a machine that pushes air into your lungs, effectively breathing for you. This is removed when you can breathe again on your own.
The long-term outlook for people who have DIC depends on how much damage the clots may have caused to the body’s tissues. About half of those with DIC survive, but some may with live with organ dysfunction or the results of amputations.
If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”
Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.
Read more about disseminated intravascular coagulation at the National Institutes of Health.
Updated August 30, 2020.