DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

MANAGEMENT

Identify and treat the underlying cause.

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

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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