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Samwel Mikaye: The Collapse of Coagulation Control in Disseminated Intravascular Coagulation
Samwel Mikaye/LinkedIn
Jun 28, 2026, 04:55

Samwel Mikaye: The Collapse of Coagulation Control in Disseminated Intravascular Coagulation

Samwel Mikaye, Medical Doctor at MSK, shared a post on LinkedIn:

“Disseminated Intravascular Coagulation (DIC)

Definition

Disseminated intravascular coagulation (DIC) is a life-threatening acquired syndrome characterized by systemic activation of coagulation, leading to widespread microvascular thrombosis, consumption of platelets and clotting factors (consumptive coagulopathy), and paradoxical bleeding.

Causes

Sepsis (most common)

  • Gram-negative
  • Gram-positive bacterial infections
  • Severe viral or fungal infection

Obstetric

  • Placental abruption
  • Amniotic fluid embolism
  • Retained dead fetus
  • Severe pre-eclampsia/eclampsia
  • Postpartum hemorrhage

Malignancy

  • Acute promyelocytic leukemia
  • Metastatic adenocarcinoma

Trauma

  • Major trauma
  • Extensive burns
  • Head injury

Others

  • Severe pancreatitis
  • Massive transfusion
  • Snake envenomation
  • Severe transfusion reactions

Pathophysiology

  • Excessive tissue factor activation
  • Widespread thrombin generation
  • Formation of fibrin microthrombi
  • Consumption of platelets and coagulation factors
  • Activation of fibrinolysis
  • Simultaneous thrombosis and bleeding
  • Organ ischemia due to microvascular occlusion

Clinical Features

Bleeding

  • Petechiae
  • Ecchymoses
  • Oozing from IV lines or surgical wounds
  • Mucosal bleeding
  • Hematuria
  • Gastrointestinal bleeding
  • Postpartum hemorrhage

Thrombosis

  • Digital ischemia
  • Deep vein thrombosis
  • Pulmonary embolism
  • Stroke
  • Multi-organ dysfunction

Organ Dysfunction

  • Acute kidney injury
  • Respiratory distress
  • Altered mental status
  • Hepatic dysfunction
  • Shock

Diagnosis

Laboratory Findings

  1. Decreased platelet count
  2. Increased PT/INR
  3. Increased aPTT
  4. Decreased fibrinogen
  5. Increased D-dimer/FDPs
  6. Blood film: schistocytes (microangiopathic hemolysis)

DIC Scoring

The International Society on Thrombosis and Haemostasis (ISTH) DIC score incorporates:

  • Platelet count
  • PT prolongation
  • D-dimer/FDP
  • Fibrinogen level

Differential Diagnosis

  • Thrombotic thrombocytopenic purpura
  • Hemolytic uremic syndrome
  • Liver failure
  • Massive hemorrhage
  • Anticoagulant overdose
  • Dilutional coagulopathy

Management

1. Treat the Underlying Cause (Most Important)

  • Prompt antibiotics for sepsis
  • Delivery in obstetric causes
  • Treat malignancy
  • Control trauma or bleeding source

2. Supportive Management

  • ABC stabilization
  • Oxygen therapy
  • Intravenous fluids
  • Vasopressors if indicated
  • Intensive care monitoring if severe

3. Blood Product Replacement (If Bleeding or Prior to Procedures)

  • Platelets if thrombocytopenic with active bleeding or very low platelet count
  • Fresh frozen plasma (FFP) for prolonged PT/aPTT with bleeding
  • Cryoprecipitate or fibrinogen concentrate if fibrinogen is low
  • Packed red blood cells for significant anemia or blood loss

4. Anticoagulation

Consider therapeutic heparin only in selected patients with predominantly thrombotic DIC and low bleeding risk.

Complications

  • Massive hemorrhage
  • Multi-organ failure
  • Acute kidney injury
  • Respiratory failure
  • Limb ischemia
  • Death.”Samwel Mikaye: The Collapse of Coagulation Control in Disseminated Intravascular Coagulation

 

Other posts featuring Samwel Mikaye on Hemostasis Today.

bleeding disorders Blood DIC Disseminated Intravascular Coagulation Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Samwel Mikaye thrombosis
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