Which of the following clinical conditions is the MOST common cause of DIC in hospitalized patients in India?

Question

Accepted Answer

D. Gram-negative sepsis. ## Epidemiology of DIC: Sepsis as the Leading Cause

**Key Point:** Gram-negative sepsis is the **single most common cause of DIC** in hospitalized patients globally and in India. It accounts for 40–50% of all DIC cases.

### Why Gram-Negative Sepsis Triggers DIC

1. **Endotoxin (LPS) Release**
   - Gram-negative bacteria release lipopolysaccharide (LPS) from their cell wall
   - LPS binds to TLR4 on monocytes and endothelial cells

2. **Tissue Factor (TF) Induction**
   - Monocytes release TF in response to TNF-α and IL-1
   - Endothelial cells also express TF
   - TF-Factor VIIa complex activates the extrinsic pathway

3. **Thrombin Generation → Microthrombi**
   - Widespread fibrin deposition in capillaries
   - Consumption of platelets and clotting factors
   - Multi-organ dysfunction (MODS)

**Clinical Pearl:** Sepsis-induced DIC is often fulminant and carries the highest mortality (50–80%) among all DIC causes.

### DIC Causes: Ranked by Frequency

| Rank | Cause | Frequency | Notes |
|------|-------|-----------|-------|
| **1** | **Sepsis (gram-negative > gram-positive)** | **40–50%** | Most common; high mortality |
| 2 | Trauma (especially head injury) | 15–20% | Tissue factor release from damaged tissue |
| 3 | Malignancy | 10–15% | APL > solid tumors; cancer cells express TF |
| 4 | Acute hemolytic transfusion reaction | 5–10% | Complement activation |
| 5 | Obstetric causes (placental abruption, amniotic fluid embolism) | 5–10% | Rare but important |
| 6 | Massive transfusion | 5% | Dilutional coagulopathy + TF from RBC transfusions |
| 7 | Acute promyelocytic leukemia (APL) | 5–10% | Leukemic cells express TF and cancer procoagulant |

**High-Yield:** In India, sepsis (especially from:
- Enteric gram-negative organisms (E. coli, Klebsiella)
- Meningococcemia
- Pneumococcal sepsis
- Malaria-associated severe disease

...is the leading cause of DIC in hospitalized patients.

### Why APL Is NOT the Most Common Cause

Although **APL is the most common cause of DIC among hematologic malignancies**, it accounts for only 5–10% of all DIC cases because:
- APL is relatively rare (2–3% of all AML)
- Sepsis is far more common in hospitalized populations
- Modern ATRA/arsenic therapy has reduced DIC incidence in APL

**Mnemonic:** **STOP** (Sepsis, Trauma, Obstetric, Promyelocytic leukemia) — but **Sepsis** is #1.

Answer

A. Massive transfusion syndrome

Answer

B. Acute promyelocytic leukemia (APL)

Answer

C. Amniotic fluid embolism

Which of the following clinical conditions is the MOST common cause of DIC in hospitalized patients in India?

Explanation

Epidemiology of DIC: Sepsis as the Leading Cause

Why Gram-Negative Sepsis Triggers DIC

DIC Causes: Ranked by Frequency

Why APL Is NOT the Most Common Cause

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Which of the following clinical conditions is the MOST common cause of DIC in hospitalized patients in India?

Explanation

Epidemiology of DIC: Sepsis as the Leading Cause

Why Gram-Negative Sepsis Triggers DIC

DIC Causes: Ranked by Frequency

Why APL Is NOT the Most Common Cause

Practice similar questions

Join our NEET PG community

Rank	Cause	Frequency	Notes
1	Sepsis (gram-negative > gram-positive)	40–50%	Most common; high mortality
2	Trauma (especially head injury)	15–20%	Tissue factor release from damaged tissue
3	Malignancy	10–15%	APL > solid tumors; cancer cells express TF
4	Acute hemolytic transfusion reaction	5–10%	Complement activation
5	Obstetric causes (placental abruption, amniotic fluid embolism)	5–10%	Rare but important
6	Massive transfusion	5%	Dilutional coagulopathy + TF from RBC transfusions
7	Acute promyelocytic leukemia (APL)	5–10%	Leukemic cells express TF and cancer procoagulant