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DIC Management Priorities — FRCA Final MCQ

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ModerateIntensive Care MedicineDIC Management PrioritiesFRCA Final

A 60-year-old woman (ASA III) in ICU with sepsis develops disseminated intravascular coagulation (DIC). Her results show: platelets 35, PT 28s, APTT 65s, fibrinogen 0.6 g/L, D-dimer >10000, and schistocytes on blood film. She is bleeding from line sites and wound. What is the most important treatment?

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Correct answer: B — Treat the underlying cause (sepsis) aggressively

The cornerstone of DIC management is treatment of the underlying cause – in this case, aggressive treatment of sepsis (antibiotics, source control, resuscitation). Without addressing the trigger, replacing blood products is futile. Supportive blood product therapy is guided by bleeding: platelets (target >50 if bleeding), cryoprecipitate (target fibrinogen >1.5 g/L), and FFP (for prolonged PT/APTT with bleeding). Heparin may be used in DIC with predominantly thrombotic manifestations but is NOT indicated in bleeding DIC. Activated protein C is no longer recommended (PROWESS-SHOCK trial showed no benefit).

Reference: BSH – 2020 – DIC guidelines; SSC – 2021 – Sepsis guidelines