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Disseminated intravascular coagulation: experience in a major cancer center
Insights
Disseminated intravascular coagulation (DIC) frequently complicates cancer, causing significant bleeding and death. Heparin treatment is often ineffective unless the underlying cancer is treated.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Disseminated intravascular coagulation (DIC) is a complex hematological disorder.
- DIC is characterized by widespread activation of coagulation, leading to microvascular thrombosis and consumption of clotting factors and platelets.
- Cancer is a known risk factor for developing DIC.
Purpose of the Study:
- To investigate the incidence and clinical characteristics of disseminated intravascular coagulation (DIC) in cancer patients.
- To evaluate the outcomes and treatment efficacy in patients with cancer-associated DIC.
Main Methods:
- Retrospective review of coagulation and medical records from 1971-1974 at Memorial Sloan-Kettering Cancer Center.
- Inclusion criteria for DIC: laboratory evidence of fibrinogen and platelet abnormalities.
- Analysis of patient demographics, tumor types, associated conditions, clinical manifestations, and outcomes.
Main Results:
- Eighty-nine patients with DIC were identified, predominantly associated with various malignancies (leukemia, myeloma, lymphoma, solid tumors).
- Bleeding occurred in 75% of patients, with a 36% mortality rate. Thromboembolism occurred in 22.5%.
- Elevated serum lactic dehydrogenase was common; heparin therapy was beneficial in only 3 of 20 patients. Eighty percent died within 30 days.
Conclusions:
- Disseminated intravascular coagulation (DIC) is a frequent and serious complication in patients with a wide range of cancers.
- DIC significantly contributes to morbidity and mortality in cancer patients.
- Effective management of cancer-associated DIC requires addressing the underlying malignancy and precipitating factors; heparin alone has limited utility.
Abstract:
Review of the coagulation laboratory records and medical records at Memorial Sloan-Kettering Cancer Center over a three year period (1971--1974) revealed 89 patients with disseminated intravascular coagulation (DIC). The diagnosis of DIC was made if laboratory studies showed evidence of quantitative and qualitative changes in fibrinogen and significant thrombocytopenia. The patients included 19 with leukemia (17 acute), 3 with multiple myeloma, 15 with lymphoma, 46 with metastatic solid tumors, (10 lung, 9 breast, 8 gastrointestinal, 12 genitourinary, 7 miscellaneous) 4 with vascular tumors, and 3 without tumor. Other conditions which might have precipitated or initiated DIC such as gram-negative sepsis, liver impairment, or mucin secreting tumors were present in the majority of patients. Bleeding occurred in 75% of the patients and was fatal in 36%. Thromboembolism occurred in 22.5%. Thirteen percent were asymptomatic. Serum lactic dehydrogenase was elevated in over 75% of the patients at the time of, or subsequent to the occurrence of DIC. Treatment with heparin was helpful in only three of twenty patients. Eighty percent of the patients died within one to over 30 days of the onset of DIC. Post mortem evidence of DIC was present in 18 of 43 autopsies. Results of this study indicate that DIC is a frequent complication of a wide variety of tumors and that its occurrence causes morbidity and mortality in a significant number of patients. Treatment with heparin is of little help unless remission is induced and the precipitating factor(s) are reversed.
