Disseminated Intravascular Coagulation (DIC) in Dogs
Overview Disseminated Intravascular Coagulation (DIC) in Dogs
Disseminated intravascular coagulation (DIC), also known as “DIC” or “Dysfibrinogen syndrome”, is a complex syndrome of disorders and deregulation of the coagulation. A cascade of events takes place within the body that leads to abnormal activation of products that encourages the blood to clot. Components such as fibrin are released within the blood stream. This can cause either very rapid clotting and possible abnormal blood clots and eventually loss of the ability to clot as the clotting ingredients are used up. Uncontrolled bleeding is the final result in this process.
The DIC condition may occur in dogs of any age, breed or sex. DIC occurs secondary to diseases that cause an inappropriate coagulation response.
Primary disorders that can cause DIC include: Neoplasia (Cancer such as Hemangiosarcoma or mammary cancer) Gastric dilatation volvulus (Bloat) Hemolytic Anemia Heartworm disease Heat stroke Anaphylaxis (Severe allergic reactions) Sepsis Trauma Shock Multiple organ dysfunction syndrome (MODS) Pancreatitis Liver failure Pyometra Von Willebrand’s Disease Vitamin K deficiency ( Rodenticide toxicosis) Other diseases that stimulate the inflammatory or immune systems
This is a very serious condition that commonly results in death.
What to Watch For
Signs associated with DIC depend on the individual pet, the length of time they have been ill and the underlying condition. Initial signs typically reflect the underlying disease or disorder. Advanced signs of DIC may include: Lethargy Weakness Pale mucous membranes or icterus (yellow) Bruising (ecchymosis) Pinpoint hemorrhages (petechiae) Bleeding from any orifice – urinary tract, blood in stool, blood in vomit, etc. Rapid breathing (tachypnea) Fast heart rate (tachycardia)
Diagnosis of Disseminated Intravascular Coagulation (DIC) in Dogs
Veterinary care should include diagnostic tests to determine the underlying disorder as well as the blood clotting parameters. There is not a single test that diagnoses DIC. Disseminated intravascular coagulation is generally diagnosed based on the presence of an underlying disease that causes DIC combined with laboratory changes that suggest problems in the coagulation (clotting) system.
Some of these tests include: Complete medical history and thorough physical examination. Special attention will be paid to any evidence of bruising or bleeding. Complete blood count (CBC) can discover anemia (too few oxygen-carrying red blood cells), abnormal platelet numbers (too few or too many blood clotting cells) and abnormal white blood cell counts (too few or too many infection-fighting cells). Infections are a common contributing factor in development of DIC. The red blood cells may be fragmented (called schistocytes) or damaged by fibrin strands that are present within the blood vessels. The platelet count is diseased in DIC. Blood smear may be preformed to evaluate the red blood cell morphology and presence of platelets. Clotting tests such as an activated clotting time (ACT), prothrombin time (PT) and activated partial thromboplastin time (APTT) are used to determine if anemia and/or bleeding are due to the inability of the animal to clot its blood. These values are greatly prolonged in the hemorrhagic phase of DIC. The values can be short in the early phases. As the pet is treated, your veterinarian will likely repeat these blood tests to confirm that they normalize. Serum fibrinogen concentration and fibrin degradation products (FDPs) are tests used to identify the presence of breakdown products of fibrin (called fibrin degradation products) can serve as an important clue to the presence of DIC. They are elevated with DIC. Packed cell volume (PCV) may be routinely monitored. This is a simple test to evaluate your dog for anemia. It determines the percentage of the blood occupied by red blood cells, which is normally 35 to 55 percent in dogs. This will help evaluate blood loss.
Additional tests may be recommended on an individual basis. They may be recommended to help evaluate or determine the underlying cause for DIC.
These tests include: Serum biochemical profile to determine potential underlying causes of DIC. Analysis of the urine to check abnormalities that be contributing to this problem. If anemia is present, a reticulocyte count determines whether the animal’s body is trying to regenerate red blood cells that have been lost. Abdominal Radiograph (X-ray) may be requested to rule out changes in size of organs like the liver or kidneys or to look for evidence of abdominal tumors. Kidney disease, intestinal disease, disease of the adrenal gland or certain abdominal tumors may be present as an underlying cause for DIC. Abdominal ultrasonography (ultrasound) uses sound waves to evaluate the contents of the abdominal cavity. A specialist often performs the test in which the fur is shaved and a probe is held against the abdomen (this is the same test given to many pregnant women to visualize the fetus). This test can reveal many of the same things as abdominal radiographs, but provides a more detailed examination along with views of the inside of organs rather than just the shadow of the organ.
Treatment of DIC in Dogs
Patients with DIC will require initial in-hospital stabilization. Treatment is primarily directed at the underlying disease. In-hospital therapy includes intensive care and frequent evaluation of bleeding and blood clotting parameters. The goal is to treat the underlying condition while trying to control hemorrhage that results from DIC.
Treatments may include the following: Identification of and aggressive treatment of the underlying condition is most important. Fluid therapy is essential to maintain adequate blood flow (perfusion). The anti-clotting medication heparin may be recommended to prevent disseminated intravascular coagulation (DIC) or if your dog is in the early stages of this life-threatening complication. Plasma that has been frozen soon after collection (fresh frozen plasma) may be administered to provide clotting factors in cases of DIC after your pet has been treated with heparin to prevent ongoing coagulation. Sometimes heparin is mixed in with the fresh frozen plasma. Blood transfusions may be recommended for pets with anemia or blood loss. Frequent monitoring of PCV’s, platelet counts, blood clotting times and other tests that can evaluate the primary cause may be preformed to help evaluate the effectiveness of a guide for additional therapy.
The prognosis depends upon the severity of the illness and the pet’s response to therapy. This condition is very serious and the prognosis is considered poor.
Home Care and Prevention
There is no long term management of DIC. Home care will depend on the underlying condition.
Aggressive and early treatment of the primary disorders that can cause DIC is the best prevention.