Disseminated Intravascular Coagulation

Occasionally the clotting mechanism becomes activated in widespread areas of the circulation, giving rise to the condition called disseminated intravascular coagulation. This often results from the presence of large amounts of traumatized or dying tissue in the body that releases great quantities of tissue factor into the blood. Frequently, the clots are small but numerous, and they plug a large share of the small peripheral blood vessels. This occurs especially in patients with widespread septicemia, in which either circulating bacteria or bacterial toxins—especially endotoxins—activate the clotting mechanisms. Plugging of small peripheral vessels greatly diminishes delivery of oxygen and other nutrients to the tissues—a situation that leads to or exacerbates circulatory shock. It is partly for this reason that septicemic shock is lethal in 85 per cent or more of patients.

A peculiar effect of disseminated intravascular coagulation is that the patient on occasion begins to bleed. The reason for this is that so many of the clotting factors are removed by the widespread clotting that too few procoagulants remain to allow normal hemostasis of the remaining blood.

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