Comprehensive Overview of DIC

Dec 21, 2024

Disseminated Intravascular Coagulopathy (DIC)

Understanding DIC

  • Terminology:
    • Disseminated: Widespread throughout an organ or the body.
    • Intravascular: Within the blood vessels.
    • Coagulopathy: Disease/problem with coagulation.
  • Definition: An abnormal response of the normal coagulation cascade leading to widespread clotting and bleeding.

Causes of DIC

  • Shock States: Neurogenic, hypovolemic, cardiogenic shock.
  • Infections: Sepsis.
  • Reactions: Transfusion reactions.
  • Gynecological/Obstetrical Complications:
    • HELP syndrome.
    • Amniotic fluid emboli.
    • Placenta abruption.
  • Blood Disorders & Other Conditions:
    • Leukemia, metastatic tumors.
    • Burns, trauma, snake bites.
    • Acute anoxia (e.g. post-cardiac arrest or drowning).

Pathophysiology of DIC

  • Two Phases:
    1. Thrombotic Phase:
      • Excessive thrombin leads to increased platelet aggregation and widespread thrombosis.
    2. Bleeding Phase:
      • Fibrin split products break down clots, depleting clotting factors and leading to hemorrhage.
  • Complications: Simultaneous clotting and bleeding.

Clinical Manifestations

  • Bleeding Signs:
    • Skin: Pallor, petechiae, purpura.
    • Respiratory: Increased rate, haemoptysis, shortness of breath.
    • Cardiovascular: Tachycardia, hypotension.
    • Gastrointestinal: GI bleeding, coffee ground emesis, rectal bleeding.
    • Genitourinary: Hematuria, oliguria, renal failure.
    • Neurologic: Altered consciousness, visual changes.
    • Musculoskeletal: Hemarthrosis.
  • Clotting Signs:
    • Skin: Cyanosis, potential gangrene.
    • Respiratory: Pulmonary emboli (PE), ARDS.
    • Cardiovascular: EKG changes, myocardial infarction.
    • Gastrointestinal: Abdominal pain, paralytic ileus.
    • Neurologic: TIAs, CVAs.

Diagnostic Tests

  • Common Tests:
    • CBC, CMP, Coagulation profiles (PT/INR, fibrinogen, plasminogen levels).
    • D-dimer (non-specific).
    • Special clotting tests as needed.

Treatment

  • Underlying Cause:
    • Sepsis: Antibiotics, fluids.
    • Snake bites: Specific antivenom treatment.
  • Supportive Care:
    • Oxygen administration.
    • Volume replacement with crystalloids, blood products (e.g., PRBCs, platelets, FFP).
    • Administration of coagulation factors if deficient.
  • Clotting Management:
    • Heparin or other anticoagulants for managing clots.

Nursing Care

  • Identify At-Risk Patients: Monitor obstetrical patients or those with known risks.
  • Monitor for Symptoms: Bleeding gums, IV site bleeding, pink-tinged urine.
  • Early Recognition and Intervention: Improves patient outcomes.

Conclusion: Understanding DIC requires knowledge of its causes, pathophysiology, symptoms, diagnostic tests, treatments, and careful nursing care to effectively manage and treat the condition.