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DIC Management — SCE Medical Oncology MCQ

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ModerateOncological EmergenciesDIC ManagementSCE Medical Oncology

A 68-year-old man with cancer and severe sepsis is found to have disseminated intravascular coagulation (DIC). His blood tests show prolonged PT/APTT, low fibrinogen (0.8 g/L), elevated D-dimer and low platelets. He is bleeding from his central line site. What is the priority in DIC management?

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Correct answer: C — Treat the underlying cause (sepsis: antibiotics, source control) AND replace coagulation factors (cryoprecipitate for fibrinogen <1.5 g/L, FFP for prolonged PT/APTT, platelets if <50 × 10⁹/L with active bleeding)

DIC is a consumptive coagulopathy requiring dual management: (1) treat the underlying cause (the most important step — sepsis treatment, cancer therapy), and (2) supportive replacement of consumed factors (cryoprecipitate to maintain fibrinogen >1.5 g/L, FFP for prolonged PT/APTT, platelet transfusion if <50 × 10⁹/L with active bleeding or <20 × 10⁹/L without). Therapeutic-dose heparin is generally NOT used in acute DIC with bleeding. Tranexamic acid should be used with caution (risk of microvascular thrombosis).

Reference: NICE NG; BSH DIC Guidelines; ISTH DIC scoring system