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Disseminated Intravascular Coagulation (DIC)Alyssa Cardinal

Don’t letthe

namefoolyou.

The term disseminated intravascular coagulation can be misleading because it suggests the blood is clotting.

This is not necessarily the case.

DIC is a massive activation of the coagulation system leading to systemic clot formation and emboli.

Consumption of clotting factors faster than synthesis leads to systemic BLEEDING!

So, what is it?

EtiologyDIC is:

not a disease

an abnormal response of the normal clotting cascade stimulated by a disease process or disorder

DIC can:occur as an acute, subacute, or chronic condition

Clinical Manifestations

Bleeding manifestations:

Pallor, petechiae, purpura, oozing blood,

venipuncture site bleeding, hematomas, and occult

hemorrhage

Respiratory manifestations:

Tachypnea, hemoptysis, and orthopnea

Cardiovascular manifestations:

Tachycardia, hypotension

GI manifestations:

Upper and lower GI bleeding, abdominal distention,

and bloody stools

Urinary manifestations:

Hematuria

Neurological manifestations

Vision changes, dizziness, headache, changes in mental

status, and irritability

Musculoskeletal manifestations

Bone and joint pain

Diagnostic Studies clotting breakdown of fibrin and fibrinogen fibrin split products (FSPs)

• FSPs interfere with blood coagulation

• D-dimer is a specific marker for the degree of fibrinolysis.

• Fragmented erythrocytes (schistocytes) may be found on blood smears.

• Tests that measure raw materials needed for coagulation (e.g., platelets, fibrinogen) are reduced, and values that measure times to clot (e.g., PT, PTT) are prolonged.

Collaborative CareDiagnose quickly

Stabilize if needed (O2, volume replacement)

Treat the underlying cause

Control the ongoing thrombosis and bleeding

Apply pressure to leaking IV/central line/arterial line sites

Administer PLATELETS to correct thrombocytopenia ifPlatelet count is < 20,000 or <50,000 with bleeding

Administer CRYOPRECIPITATE to replace factor VIII and fibrinogen if the fibrinogen level is < 100 mg/dL

FRESH FROZEN PLASMA replaces all clotting factors except platelets and provides a source of antithrombin

HEPARIN therapy is used to treat thrombosis, ONLY when the benefit (reduce clotting) outweighs the risk (further bleeding)

Chronic DIC does not respond to oral anticoagulants, but it can be controlled with long-term use of HEPARIN

Nursing Diagnoses Ineffective peripheral tissue perfusion related to

bleeding and sluggish or diminished blood flow secondary to thrombosis

Acute pain related to bleeding into tissues and diagnostic procedures

Decreased cardiac output related to fluid volume deficit

Anxiety related to fear of the unknown, disease process, diagnostic procedures, and therapy

QUIZ1. Which of the following is true in relation to DIC? (select the

best answer)a. DIC exhibits widespread clotting in capillaries.b. DIC results in systemic bleedingc. The consumption of clotting factors leads to hemorrhaged. A and B onlye. All of the above

QUIZ1. Which of the following is true in relation to DIC? (select

the best answer)a. DIC exhibits widespread clotting in capillaries.b. DIC results in systemic bleedingc. The consumption of clotting factors leads to hemorrhaged. A and B onlye. All of the above

QUIZ1. Which of the following are primary causes of DIC? (select all that

apply)a. Shockb. Septicemiac. Mismatched blood transfusionsd. Abruptio placentaee. Cancerf. Fat and pulmonary embolig. Acute anoxiah. Burnsi. Snakebitesj. Systemic lupus erythematosus

QUIZ1. Which of the following labs are prolonged in DIC?

a. PTb. PTTc. Fibrinogend. Platelets

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