Disseminated Intravascular Coagulation

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In paediatric oncology, this is most often seen with:

• gram negative sepsis

• AML at diagnosis particularly M3 and M4/5

• advanced neuroblastoma (particularly stage 4S)

• ALL with hyperleucocytosis

• haemophagocytic syndromes.

Diagnosis is confirmed by prolonged PT, APTT, low platelets, low fibrinogen and high fibrin degradation products (latter measured as D-dimer concentration).

Treatment of DIC

• treat underlying cause
• keep platelets > 50 x 10⁹/l
• FFP 10 - 15 mls/kg over 1 -2 hours repeated 8 -12 hourly if necessary
• cryoprecipitate 5 - 10 mls/kg over 1 hour given 8 - 12 hourly as necessary.