Summary
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.
