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Disseminated intravascular coagulation in cancer

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2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Bleeding or organ-threatening cancer DIC

Diffuse bleeding, rapidly falling platelets or fibrinogen, prolonged clotting, schistocytes, acral ischaemia, thrombosis or organ failure in cancer indicates active disseminated intravascular coagulation.

Action: Use ABCDE care, send and repeat a complete coagulation and haemolysis profile, call haematology and the tumour team urgently, control the cause, start all-trans retinoic acid immediately when acute promyelocytic leukaemia is suspected and support clinically important bleeding with targeted blood components.

Synopsis

Recognise evolving systemic coagulation activation in cancer, distinguish bleeding- and thrombosis-dominant phenotypes, treat the malignant or infective trigger and use components and anticoagulation according to clinical need.

  • DIC is an acquired systemic process of excessive coagulation activation with factor and platelet consumption, secondary fibrinolysis and variable bleeding, thrombosis and organ failure.
  • Cancer causes acute haemorrhagic DIC in APL, chronic thrombotic DIC in metastatic adenocarcinoma and mixed phenotypes intensified by sepsis, surgery or treatment.
  • First-line tests are serial platelet count, PT, APTT, fibrinogen and D-dimer with blood film, haemoglobin, renal, liver and haemolysis assessment; no single normal result excludes early DIC.

Key red flags

Headache, focal neurology, reduced consciousness or severe hypertension with coagulopathy requires urgent intracranial bleeding assessment.

APL emergency pattern

Bruising, mucosal bleeding and abnormal coagulation with abnormal promyelocytes or pancytopenia requires immediate ATRA and haematology support.

Investigation priorities

01
First-line serial DIC panelFirst stepFirst line

Detect consumption and fibrin turnover and measure its direction over hours.

Management branches

RecogniseConfirm a changing syndrome

Cancer coexists with bleeding, thrombosis, falling platelets or abnormal coagulation.

  1. Assess ABCDE, bleeding sites, skin and limb perfusion, neurological state and infection and obtain serial DIC panel, film, haemolysis and organ tests.
  2. Identify the likely trigger and use the ISTH score as supporting structure while acting immediately on major bleeding, shock or limb and brain threat.

Key medicines

All-trans retinoic acid for suspected APLGive tretinoin 45 mg/m² per day orally in two divided doses immediately when APL is suspected, continuing under the risk-adapted specialist protocol while urgent PML-RARA confirmation is obtained.
Fresh frozen plasmaFor active bleeding with prolonged PT or APTT, use the current transfusion-guideline adult dose, commonly 12 to 15 mL/kg, then reassess bleeding and coagulation rather than transfusing to a laboratory number alone.
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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.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom