What causes disseminated intravascular coagulation?

Disseminated intravascular coagulation (DIC) is always secondary to an underlying disorder.

The pathological situations that cause DIC are shown in Table I.
DIC may be fulminant (progressing rapidly, sometimes overwhelming) or less severe.

Fulminant DIC can be a complication of the following clinical situations:

severe bacterial infection due to Gram-positive or Gram-negative bacteria that can cause septic shock,
severe trauma, for example crush injuries or extensive burns,
certain obstetrical conditions, the main one being amniotic fluid embolism,
intravascular haemolysis,
some malignancies, particularly certain leukaemias or solid tumours (pancreas, prostate),
certain liver disorders.

Overt/decompensated DIC
Infection • Gram-negative bacteria (endotoxins) • Gram-positive bacteria (mucopolysaccharides)	Intravascular haemolysis • Haemolytic transfusion reaction • Haemolysis • Massive transfusion
Trauma • Severe tissue injury (burns, crush injury) • Head injury • Fat embolism	Malignancy • Leukaemias (e.g. AML M3 and M4) • Solid tumours (e.g. pancreas and prostate)
Obstetrical complications • Amniotic fluid embolism • Abruptio placentae • Missed abortion • Eclampsia, abortion	Toxicity • Drugs (e.g. amfetamines) Liver disorders • Acute liver failure • Cholestatic jaundice

Non-overt/compensated DIC
Cardiovascular disease • Stent valves • Giant haemangiomas • Aneurysm	Haematological diseases Inflammatory syndromes
Renal vascular disease	Autoimmune diseases • Graft rejection

Table I: The main disorders associated with DIC
(adapted from Prieto M. International Congress Series. 2002;1237:163–8)