๐Ÿฉธ Chapter 532 ยท Disseminated Intravascular Coagulation (DIC)

Nelson Textbook of Pediatrics 22nd Edition | DIC is an acquired syndrome of widespread coagulation activation leading to microvascular thrombi, consumption of platelets and clotting factors, and bleeding. Causes: sepsis (meningococcemia), trauma, malignancy, purpura fulminans, snake envenomation. Laboratory: thrombocytopenia, prolonged PT/PTT, low fibrinogen, elevated D-dimer, schistocytes. Treatment: treat underlying cause; supportive with FFP, cryoprecipitate, platelets. Avoid rFVIIa and antifibrinolytics (may worsen thrombosis).

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๐Ÿ“‹ 30 Clinical Scenarios โ€” Disseminated Intravascular Coagulation (DIC)

๐Ÿ“‡ Highโ€‘Yield Review Cards (DIC)

๐Ÿฉบ Clinical Recognition: DIC

Select a presentation for diagnostic clues and management.

๐Ÿ“‹ Stepwise Management of DIC

๐Ÿ”‘ Key Principles โ€” Nelson Chapter 532
โ€ข Pathophysiology: Widespread activation of coagulation โ†’ microthrombi โ†’ consumption of platelets and clotting factors โ†’ bleeding.
โ€ข Laboratory findings: Thrombocytopenia, prolonged PT/PTT, low fibrinogen, elevated D-dimer, schistocytes.
โ€ข Treatment of underlying cause (sepsis, trauma, malignancy) is paramount.
โ€ข Supportive care (with bleeding): FFP 10-15 mL/kg, cryoprecipitate (fibrinogen <100 mg/dL), platelets (if <50,000 with bleeding).
โ€ข Avoid: rFVIIa (may worsen thrombosis), antifibrinolytics (tranexamic acid) unless hyperfibrinolysis predominates (e.g., acute promyelocytic leukemia, trauma).
โ€ข Heparin: Not routinely indicated; consider in purpura fulminans (homozygous protein C deficiency) with DIC.

    โšก Reflex Prompts โ€” Clinical Decisions in DIC

    ๐Ÿ“– Summary: Disseminated Intravascular Coagulation โ€” Nelson Ch 532