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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.

Disseminated intravascular coagulation

Haematology and transfusion · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
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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.
  • Management priority is rapid control of the driver: antimicrobials and source control for sepsis, delivery or obstetric haemorrhage control, trauma haemostasis, or immediate ATRA for suspected APL.
  • Do not transfuse solely to normalise numbers in a non-bleeding patient; give platelets, plasma and fibrinogen replacement for significant bleeding or a high-risk procedure using clinical and laboratory guidance.
  • For active bleeding with platelets below 50 × 10⁹/L, platelet transfusion is generally considered; plasma provides multiple factors when PT or APTT is prolonged and bleeding is present.
  • If fibrinogen remains critically low during bleeding, use cryoprecipitate or fibrinogen concentrate according to the major-haemorrhage protocol and reassess promptly.
  • Therapeutic heparin is not routine for bleeding DIC, but may be used with specialist oversight when thrombosis predominates; prophylactic VTE prevention remains important when bleeding risk permits.

    • Key red flags

    Hypotension, altered consciousness, oliguria, hypoxaemia or rising lactate indicates organ hypoperfusion and requires immediate source control and critical-care escalation.

    Diffuse oozing from venepuncture sites, gastrointestinal bleeding, intracranial symptoms or rapidly expanding postoperative bleeding requires the major-haemorrhage pathway alongside DIC treatment.

    Painful cyanotic digits, retiform purpura, symmetrical peripheral gangrene or new venous or arterial occlusion indicates clinically important thrombosis despite prolonged clotting tests.

    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.

    1. Perform ABCDE assessment, obtain blood before treatment when this causes no delay, and contact the relevant source-control team.
    2. Send serial platelet count, film, PT, APTT, fibrinogen and D-dimer and document sites of bleeding and thrombosis.
    3. Use a validated overt-DIC score as supporting evidence, repeat it with clinical change and actively test important mimics.

    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.Do not use simply to correct laboratory values in a non-bleeding patient. Consider circulatory overload, allergic reaction and the time and volume needed for effect; arrange urgent haemostasis rather than repeated empirical plasma.
    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.Thresholds vary with major-haemorrhage and obstetric protocols; avoid number-driven use without bleeding, and record component exposure, response and thrombotic risk.
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    Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    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.

    • British Society for Haematology: diagnosis and management of disseminated intravascular coagulationUK clinicopathological diagnosis, serial assessment and treatment principles.
    • NICE NG24: blood transfusion recommendationsUK platelet, plasma and cryoprecipitate thresholds and reassessment.
    • NICE NG51: sepsis recognition, diagnosis and early managementImmediate sepsis assessment, antimicrobials and source-control context.
    • NICE NG39: major trauma assessment and initial managementMajor-haemorrhage and damage-control resuscitation principles.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom