Disseminated intravascular coagulation D65.1

Acquired breakdown of hemostasis involving platelets, epithelium, coagulation factors, fibrinolysis, inhibitors, complement and the kininogen system. The result is acute intravascular coagulation of varying aetiology with formation of numerous microthrombi, consumption of all coagulation active substances (platelets, fibrinogen, coagulation factors) and a consecutive tendency to bleed.

Disseminated intravascular coagulation (DIC) is a disorder that can have many causes, all of which converge on a common etiopathogenetic final pathway. The basis of the disorder is a consumption of platelets, coagulants, and anticoagulants to an extent that can no longer be compensated by the synthesis of these substances . Therefore, localized or generalized hemorrhagic diatheses, thromboses in the microcirculation, tissue necrosis and multiple organ failures occur.

Triggers are often bacterial infections by streptococci, staphylococci, pneumococci, meningococci, gram-negative rods, but also viruses, parasites, rickettsiae or mycoses. Other causes are endothelial damage, e.g. in the context of a haemolytic-uraemic syndrome, acute glomerulonephritis or Rocky Mountain fever.

Other feared causes are obstetric complications such as placental abruption, amniotic fluid embolism, septic abortion, intrauterine amniotic death and eclampsia.

Other frequent causes are neoplasms such as adenocarcinomas, acute promyelocytic leukaemia, but also severe haemolyses. Furthermore, tissue damage, such as burns, frostbite and gunshot wounds, can trigger a consumption coagulopathy.

An important cause of DIC is acute promyelocytic leukemia. The leukemic promyelocytes produce a leukocyte elastase that proteolytically destroys alpha-2 antiplasmin, factor-V, fibrin, and plasmin. In addition, promyelocytes produce t-PA and urokinase.

Several fatal cases of disseminated intravascular coagulation have occurred during the current COVID-19 vaccination campaigns with Astra-Seneca 's vector vaccine . The fatal disseminated coagulation episodes occurred within a 14-day period after vaccination. Persons <55 years of age were affected more frequently. Women were affected more frequently ( EMA communication of 18.3.2021).

A cause of DIC that is rare in Europe is the venom of the Malayan moccasin viper. It contains enzymes that destroy fibrin and have thrombin-like effects. These effects are not antagonizable by AT-III.

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