<prompt> Which statement is most appropriate for DIC:Increased fibrinogenIncreased D dimerResolves if causative factor removedAbsence of bleeding abnormalities rules out DIC  <response>: Ans: B Increased D dimer Ref: Harrisons Principles of Internal Medicine, 18th ed Explanation: Disseminated Intravascular Coagulation DIC is a clinicopathologic syndrome characterized by widespread intravascular fibrin formation in response to excessive blood protease activity that overcomes the natural anticoagulant mechanisms. The most common findings are bleeding ranging from oozing from venipuncture sites, petechiae, and ecchymoses to severe hemorrhage from the gastrointestinal tract, lung, or into the CNS. In chronic DIC. the bleeding symptoms are discrete and restricted to the skin or mucosal surfaces. The hypercoagulability of DIC manifests as the occlusion of vessels in the microcirculation and resulting organ failure. Thrombosis of large vessels and cerebral embolism can also occur. Hemodynamic complications and shock are common among patients with acute DIC. The mortality ranges from 30 to 80 depending on the underlying disease, the severity of the DIC. and the age of the patient. Lab Findings Prolongation of PT andor aPTT. Platelet counts 1,00,000L3 or a rapid decline in platelet numbers. Presence of schistocytes fragmented red cells in the blood smear: and Elevated levels of FDP. The most sensitive test for DIC is the FDP level. DIC is an unlikely diagnosis in the presence of normal levels of FDP. The D-dimer test is more specific for detection of fibrin--but not fibrinogen--degradation products and indicates that the crosslinked fibrin has been digested by plasmin. Because fibrinogen has a prolonged half-life, plasma levels diminish acutely only in severe cases of DIC. High-grade DIC is also associated with levels of antithrombin III or plasminogen activity 60 of normal. Common Clinical Causes of Disseminated Intravascular Coagulation Sepsis Immunologic disorders Bacterial Staphylococci, streptococci, pneumococci, meningococci, gram-negative bacilli Viral Mycotic Parasitic Rickettsial Acute hemolytic transfusion reaction Organ or tissue transplant rejection Graft-versus-host disease Trauma and tissue injury Drugs Brain injury gunshot Extensive burns Fat embolism Rhabdomyolysis Firinolyftc agents Aprctimn Warfarin especially in neonates with protein C deficiency Prothrombin complex concentrates Recreational drugs amphetamines Vascular disorders Envenomation Giant hemangiomas Kasabach- Merritt syndrome Large vessel aneurysms e.a., aorta Snafee Insects Obstetrical complications Liver disease Abruptio placentae Amnio tic-flu id embolism Dead fetus syndrome Septic abortion Fulminant hepatic failure Cirrhosis Fatty liver of pregnancy Cancer Miscellaneous Adenocarcinoma prostate, pancreas, etc. Hematologic malignancies acute promyelocytic leukemia Shock Respiratory distress syndrome Massive transfusion 