Disseminated intravascular coagulation in patients with solid tumors.

Disseminated intravascular coagulation (DIC) is an occasional complication of solid tumors, usually identified at the time of presentation because of excessive bleeding, thromboembolic complications, or abnormal laboratory test results. The latter include an unexplained low platelet count, a low fibrinogen level, an elevated D-dimer level, and a prolonged prothrombin time. Prompt diagnosis and treatment of the underlying malignancy can result in resolution of the DIC. Further, if the tumor is responsive to chemotherapy, a reasonable median survival can also result. Excessive bleeding at presentation can be managed with platelet transfusions, cryoprecipitate, and fresh frozen plasma. Thromboembolic complications can be managed with continuous intravenous heparin and supportive platelet transfusions; cryoprecipitate can be used whenever necessary to support platelet and fibrinogen levels. On occasion, when excessive bleeding and venous thromboembolism occur together, placement of a vena cava filter is required, along with the administration of platelets and cryoprecipitate.