Disseminated Intravascular Coagulation

Is a complex syndrome of activated coagulation that results in bleeding and

thrombosis. It is basically loss of balance between the clotting and lysing systems in
the body caused by simultaneous presence of thrombin and plasmin.

Pathophysiology:

Activation of tissue factor triggers coagulation pathways

Extrinsic Coagulation Pathway

Intrinsic Coagulation Pathway

Both pathways release substance that activates thrombin formation, presence of

thrombin activates the release of fibrinogen. Increased production of thrombin
results in deposition of fibrin throughout the microcirculation (Suppression of
anticoagulation mechanism and delayed removal of fibrin because of impaired
fibrinolysis also triggers fibrin formation)

Fibrin deposition throughout the microcirculation and platelet aggregation in

increased

Excessive clotting activates fibrinolytic Enabling fibrin clots

and microthrombi to
Mechanism form in the organs, RBC becomes
trapped in
The fibrin strands and are destroyed
Causing production of fibrin degradation
products Sluggish circulation of the blood
reduces the
flow of nutrients & oxygen to the
cell
Leading to inhibition of clotting factors
Clotting factors are consumed in
the process
Compromising coagulation

With lysis of clots and depletion of clotting factors, the blood loses its ability to clot

Bleeding
Laboratory and Diagnostic Tests:

1. Prothrombin- prolonged

2. Thrombin time- prolonged

3. Fibrinogen level- decreased

4. Platelet count- decreased

5. Fibrin degradation products- increased

Medication:

1. IV heparin – to control thrombosis

2. Protease Inhibitors and Aprotinin- used to control bleeding

3. Anithrombin- coagulation inhibitor

Nursing Intervention:

Minimizing bleeding

1. Monitor pad count and amount of saturation during menses; administer or

teach self administration of hormones to suppress menstruation as
prescribed.

2. Administer blood products as ordered, monitor for signs and symptoms of

allergic reaction

3. Avoid dislodging clots. Apply pressure to sites of bleeding of at least 20 mins.

4. Maintain bed rest during bleeding episodes.