Wednesday, December 5, 2012

Disseminated Intravascular Coagulation

The way to think of this problem is not so much to look at it and say "DIC" but rather to look at it and say to yourself "This is clearly a vascular problem which resulted in small vessel obstruction, followed by bleeding into that same compromised vascular distribution".  As such, you would come up with a ddx which would, eventually, include DIC.  

Think of DIC as not really a disease, but rather a manifestation of disease, whether it be from sepsis, trauma, systemic disease (e.g. pancreatitis), malignancy associated thrombotic changes, envenomations from certain snakes, or anything else which could trigger the coagulation cascade (abruptio placenta, weird manifestations of antiphospholipid syndrome, etc.)

On a localized level, therefore, I would include frostbite, which most of you listed, as one of these phenomenae, so don't feel bad for listing it.  I've seen frostbite that looks just like this, and although I have never seen DIC in person, I suspect there would be plenty of other clues to figure that out.  I also doubt I would have the presence of mind to take a pic of DIC unless, like above, the patient survived.

A few of you listed DIC and one of you (you know who you are) listed ONLY DIC, which was a pretty bold move.  

Interstingly, the inflammatory cytokines seen in certain trauma patients mimic the profile seen in sepsis, and the current theory is that it is the cytokines which trigger the cascade leading to DIC.

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