DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

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MANAGEMENT

Identify and treat the underlying cause.

If the patient is bleeding, replace haemostatic factors with cryoprecipitate or fresh frozen plasma.

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If the patient is not actively bleeding and platelet count > 20 000, then platelet transfusion is not necessary.

Replacement therapy for thrombocytopenia should consist of 1 apheresis single donor unit / megaunit (expected platelet count increment 30–50 x 109/L) or 6 random donor units (expected increment 50–60 x 109/L), ideally aiming to raise the platelet count > 50 x 109/L.

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In chronic DIC, or in the absence of bleeding, platelet transfusions should not be given merely to correct the thrombocytopenia.

For hypofibrinogenaemia:

  • Cryoprecipitate, 8–10 units.

For depletion of other coagulation factors:

  • Fresh frozen plasma, 2–4 units, i.e. 15–20 mL/kg as initial dose o Volume: ±280 mL/unit.

Repeat replacement therapy 8 hourly or less frequently, with adjustment according to the clinical picture and laboratory parameters.

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Perform frequent estimation of the platelet count and coagulation screening tests.

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