Disseminated Intravascular Coagulation (DIC)

  1. General information
    1. Diffuse fibrin deposition within arterioles and capillaries with widespread coagulation all over the body and subsequent depletion of clotting factors.
    2. Hemorrhage from kidneys, brain, adrenals, heart, and other organs.
    3. Cause unknown
    4. Clients are usually critically ill with an obstetric, surgical, hemolytic, or neoplastic disease.
    5. May be linked with entry of thromboplastic substances into the blood.
    6. Pathophysiology
      1. Underlying disease (e.g., toxemia of pregnancy, cancer) causes release of thromboplastic substances that promote the deposition of fibrin throughout the microcirculation.
      2. Microthrombi form in many organs, causing microinfarcts and tissue necrosis.
      3. RBCs are trapped in fibrin strands and are hemolysed.
      4. Platelets, prothrombin, and other clotting factors are destroyed, leading to bleeding.
      5. Excessive clotting activates the fibrinolytic system, which inhibits platelet function, causing further bleeding.
    7. Mortality rate is high, usually because underlying disease cannot be corrected.
  2. Medical management
    1. Identification and control of underlying disease is key
    2. Blood transfusions: include whole blood, packed RBCs, platelets, plasma, cryoprecipitates, and volume expanders
    3. Heparin administration
      1. Somewhat controversial
      2. Inhibits thrombin thus preventing further clot formation, allowing coagulation factors to accumulate
  3. Assessment findings
    1. Petechiae and ecchymoses on the skin, mucous membranes, heart, lungs, and other organs
    2. Prolonged bleeding from breaks in the skin (e.g., IV or venipuncture sites)
    3. Severe and uncontrollable hemorrhage during childbirth or surgical procedures
    4. Oliguria and acute renal failure
    5. Convulsions, coma, death
    6. Laboratory findings
      1. PT prolonged
      2. PTT usually prolonged
      3. Thrombin time usually prolonged
      4. Fibrinogen level usually depressed
      5. Platelet count usually depressed
      6. Fibrin split products elevated
      7. Protamine sulfate test strongly positive
      8. Factor assays (II, V, VII) depressed
  4. Nursing interventions
    1. Monitor blood loss and attempt to quantify.
    2. Observe for signs of additional bleeding or thrombus formation.
    3. Monitor appropriate laboratory data.
    4. Prevent further injury.
      1. Avoid IM injections.
      2. Apply pressure to bleeding sites.
      3. Turn and position client frequently and gently.
      4. Provide frequent nontraumatic mouth care (e.g., soft toothbrush or gauze sponge).
    5. Provide emotional support to client and significant others.
    6. Administer blood transfusions and medications as ordered.
    7. Teach client the importance of avoiding aspirin or aspirin-containing compounds.