The skin in disseminated intravascular coagulation

The cutaneous manifestations of disseminated intravascular coagulation (DIC) present in thirty-three of forty-five patients included petechiae, purpura, palpable variants of both, acral cyanosis, haemorrhagic bullae, purpura fulminans, subcutaneous dissecting haematomata, or bleeding from wound or venipuncture sites. In 47% of cases cutaneous lesions were the presenting sign. Coagulation tests were usually abnormal in a pattern diagnostic of DIC. However when initial coagulation-test observations were equivocal, punch biopsy of the skin yielded fibrin thrombi and thus was helpful in the early diagnosis of DIC, later confirmed by serial coagulation studies. Recognition of the types of skin lesions associated with DIC permits prompt diagnosis and institution of appropriate therapy.