DIC Disseminated Intravascular Coagulopathy

Aug 17, 2024

Introduction

  • DIC stands for Disseminated Intravascular Coagulopathy.
  • Disseminated: Widespread throughout the body.
  • Intravascular: Within blood vessels.
  • Coagulopathy: Problem with coagulation.
  • DIC: Abnormal response of the coagulation cascade.

Causes of DIC

  • Shock States: Neurogenic, hypovolemic, cardiogenic shock.
  • Sepsis: Common cause.
  • Transfusion Reactions: Can lead to DIC.
  • Gynecological/Obstetrical Conditions: HELLP syndrome, amniotic fluid emboli, placental abruption.
  • Blood Disorders: Leukemia, metastatic tumors.
  • Other Causes: Burns, trauma, poisonous snake bites, acute anoxia (post-cardiac arrest or drowning).

Pathophysiology

  • Thrombotic Stage

    • Thrombin converts fibrinogen to fibrin to form clots.
    • Leads to increased platelet aggregation.
    • Abnormal widespread thrombi formation.

  • Bleeding Stage

    • Clots broken down by fibrin split products (FSP).
    • All clotting factors and platelets used up.
    • Results in hemorrhage.
    • Clotting and bleeding can occur simultaneously.

Signs and Symptoms

  • Bleeding Symptoms

    • Skin: Pallor, petechiae, purpura.
    • Respiratory System: Increased respiratory rate, hemoptysis, shortness of breath.
    • Cardiovascular System: Increased heart rate, decreased blood pressure, GI bleeding.
    • Neurologic System: Altered consciousness, vision changes.
    • GU System: Hematuria, oliguria.

  • Clotting Symptoms

    • Skin: Cyanosis, gangrene.
    • Respiratory System: Pulmonary emboli, ARDS.
    • Cardiovascular System: EKG changes, myocardial infarction, heart failure, JVD.
    • Neurologic System: TIAs, CVAs.
    • Musculoskeletal: Hemarthrosis.

Diagnostic Tests

  • CBC: Blood count.
  • CMP: Kidney, liver function, electrolytes.
  • Coagulation Tests: Bleeding times, PT/INR, fibrinogen level, plasminogen level, platelets, D-dimer (non-specific), fibrin split products.

Treatment

  • Underlying Cause
    • Treat sepsis (antibiotics, fluids).
    • Treat snake bites and other specific causes.
  • General Management
    • Oxygen administration.
    • Maintain airway.
    • Volume replacement (crystalloids, blood products).
    • Blood products: Packed red blood cells, platelets, fresh frozen plasma, coagulation factors.
    • Manage clotting: Heparin drip, Lovenox.

Nursing Care

  • Identify patients at risk.
  • Monitor for bleeding signs: IV sites, gums, GI tract, urine.
  • Early recognition and intervention improve outcomes.

Conclusion

  • Understanding DIC and its causes can lead to better patient outcomes through early detection and treatment.
  • Further study recommended on disorders leading to DIC.