148. In the Eye of the Storm - An Approach to Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DIC) is a life-threatening systemic dysregulation of the coagulation system always secondary to an underlying insult such as sepsis, trauma, or malignancy. Driven primarily by the release of tissue factor from monocytes and endothelial cells, the condition creates a vicious cycle of simultaneous widespread clotting and consumption-related bleeding. Diagnosis relies on the International Society of Hemostasis and Thrombosis score, which evaluates platelet counts, D-dimer, fibrinogen, and INR levels. Distinguishing DIC from mimics like hepatic cirrhosis or thrombotic thrombocytopenic purpura is critical, particularly as the presence of schistocytes on a blood smear indicates a hematologic emergency. Management focuses strictly on treating the provocative cause—such as administering all-trans-retinoic acid for acute promyelocytic leukemia—rather than correcting laboratory numbers, as blood product replacement is reserved for overt hemorrhage or pre-procedural stabilization.