Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Bleeding, thrombosis and organ failure
Shock, uncontrolled wound or line bleeding, acral ischaemia, purpura fulminans, neurological change, hypoxaemia or oliguric kidney injury may represent rapidly evolving overt DIC.
Action: Use ABCDE assessment, control the precipitant, activate major-haemorrhage support when appropriate, send serial FBC, film, PT, APTT, fibrinogen and D-dimer, crossmatch blood, involve haematology and critical care early, and give components for clinically important bleeding without waiting for every result.
Synopsis
Recognise disseminated intravascular coagulation as a changing clinicopathological syndrome, treat its cause urgently, and use blood components or anticoagulation according to bleeding and thrombotic risk rather than abnormal tests alone.
DIC is an acquired systemic activation of coagulation caused by another disorder; a laboratory pattern without an appropriate clinical trigger is not sufficient.
First-line assessment is serial FBC and film, PT, APTT, fibrinogen and a fibrin-related marker such as D-dimer, interpreted with bleeding, thrombosis and organ function.
A falling platelet count and fibrinogen, prolonging PT and rising D-dimer are more informative than one isolated result; early sepsis-related DIC may have a normal fibrinogen.
Key red flags
Hypotension, altered consciousness, oliguria, hypoxaemia or rising lactate indicates organ hypoperfusion and requires immediate source control and critical-care escalation.
APL phenotype
Promyelocytes, bruising, mucosal bleeding and profound fibrinogen depletion require immediate ATRA discussion before molecular confirmation.
Investigation priorities
01
First-line: FBC and peripheral filmFirst stepFirst line
Measure platelet consumption, anaemia and alternative cell abnormalities.
02
First-line: PT, APTT, fibrinogen and D-dimerFirst line
Identify consumption and fibrin formation or breakdown and establish a trend.
Management branches
Suspected DICConfirm syndrome while treating cause
A recognised trigger coexists with bleeding, thrombosis, organ dysfunction or evolving coagulation abnormalities.
Perform ABCDE assessment, obtain blood before treatment when this causes no delay, and contact the relevant source-control team.
Send serial platelet count, film, PT, APTT, fibrinogen and D-dimer and document sites of bleeding and thrombosis.
Key medicines
Fresh frozen plasmaFor clinically significant bleeding with abnormal coagulation, give a typical initial dose of 15 mL/kg intravenously under the local transfusion protocol, then reassess bleeding, PT, APTT and fluid status before further doses.
CryoprecipitateGive two pooled adult doses intravenously for clinically significant bleeding with low fibrinogen under the local major-haemorrhage protocol, then repeat fibrinogen and assess haemostasis before redosing.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.