Richard, that's a tough one. I've seen a couple of cases of DIC and neither patient was conscious for an explanation, and neither patient survived it. If you did need to explain it to the patient or family/friends, I guess you would need to keep it simple and explain that the patients blood is coagulating in places it shouldn't, causing a drop in the patients platelet count, and the outlook is not good. Usually doctors are going to want to transfuse with FFP and platelets when this happens, so that makes it even more difficult when you are dealing with patients who will not take blood products. I would also tell patients/family that you would check to see if there are any options or new treatments available for this disorder so as not to leave them without hope. If you have a patient with DIC, I feel your pain as a coordinator, there's not alot you can do or say to make the situation better.

Disseminated intravascular coagulopathy (DIC) is a dysfunction of the coagulation system, often triggered by sepsis in obstetric patients. Basically, what happens is that there is an abnormal production of tissue factor (TF) that blocks the tiniest capillaries, causing tissue damage due to ischemia (oxygen starvation). At the same time, plasmin activation occurs, resulting in fibrinolysis (destruction of the clotting factor fibrin). A cycle is thus set up in which the more fibrinolysis occurs the more TF is produced, leading to more fibronolysis, as well as depletion of platelets and clotting factors. If not treated promptly, DIC can have extremely serious consequences including uncontrollable hemorrhage.

The conventional treatment for DIC has usually included transfusion of red blood cells and/or platelets, and sometimes cryoprecipitate, though the latter is controversial since it has the potential to "add fuel to the fire" of the coagulopathy. Alternative treatments that do not involve the transfusion of major blood components include antithrombin III, activated protein C, or synthetic serine protese inhibitors. (http://www.ncbi.nlm.nih.gov/pubmed/9...citationsensor.) Antifibrinolytic agents such as tranexamic acid have also proved useful in these cases, and nowadays recombinant factor VIIa should probably be the drug of first choice in any case of major uncontrolled bleeding. See

Blood Coagul Fibrinolysis. 2007 Oct;18(7):589-93.

Potential role of recombinant activated factor VII for the treatment of severe bleeding associated with disseminated intravascular coagulation: a systematic review

Franchini M, Manzato F, Salvagno GL, Lippi G.
Immunohematology and Transfusion Center, City Hospital of Verona, Italy. mfranchini@univr.it

Recombinant activated factor VII (rFVIIa) is a novel hemostatic agent, originally developed for the treatment of hemorrhage in hemophiliacs with inhibitors, which has been successfully used recently in an increasing number of nonhemophilic bleeding conditions. In the present systematic review we report the existing literature data on the use of this hemostatic agent in severe bleeding, unresponsive to standard treatment, associated with disseminated intravascular coagulation. A total of 99 disseminated intravascular coagulation-associated bleeding episodes treated with rFVIIa were collected from 27 published articles: in the majority of the cases, the underlying disorder complicated by disseminated intravascular coagulation was a postpartum hemorrhage, while in the remaining cases it was a cancer, trauma, sepsis or liver failure. Although limited, the data available suggest that rFVIIa could have a potential role in this clinical setting. Large randomized trials are needed, however, to confirm the preliminary results and to assess the safety and dosing regimens of this agent in refractory bleeding associated with disseminated intravascular coagulation.

PMID: 17890943 [PubMed - indexed for MEDLINE]

Of course, any treatment regime must also address the underlying cause (e.g., sepsis).

Mark, Thank you for your kind words. Fortunately I yet to have a DIC patient but certainly want to be prepared. It has only been in conversation that DIC has come up and if I ever had a patient in this situation I would want to be as informed as possible.

Informaticus, thank you for explaining DIC. I feel this explanation will help in understanding this dreaded condition. I requested the article and am looking forward to reading it.

You might want to try to find how they treated the two successful bloodless cases at either Cleveland Clinic or St Josephs in Cleveland OH. To my knowledge, it was just using EPO and was several, maybe even over 10 years ago.

I have seen it in non-OB patients when broad spectrum antibiotics are used for massive infections. All the patients I knew of died. None were bloodless.