Disseminated I ntravascular Coagulation in the Neonatal Period

Introduction
Disseminated intravascular coagulation (DIC) is a disorder of hemostasis that may occur
in the neonatal period as a complication of various other disease processes. Its effects
on the newborn, especially a premature or otherwise sick infant, can be particularly
devastating.
As with many other body systems in the neonate, the hematologic system is immature
at birth. As a result, newborns may be at an increased risk for various problems.
Bleeding disorders in an infant can be viewed in two categories: inherited or acquired.
Inherited disorders include factor deficiencies such as hemophilia, von Willebrand
disease, and both autoimmune and alloimmune thrombocytopenias. The most common
acquired disorders are vitamin K deficiency, liver disease, and disseminated
intravascular coagulation secondary to some underlying cause.
Disseminated intravascular coagulation continues to be a topic of recent discussion due
to its prevalence in the sick or premature newborn. DIC is complex and varies in
etiology, presentation, diagnosis, and treatment
Etiology
DIC is not a primary diagnosis, but instead a secondary coagulation disorder that
complicates various primary conditions. The range of presentation varies widely with
the underlying status of the infant and the severity of the triggering event. Some of the
most common underlying pathologies are asphyxia, sepsis, and respiratory distress
syndrome (RDS). It is postulated that the acid-base imbalances and shock that often
accompanies these common neonatal problems cause a release of endotoxins and
endothelial damage. These in turn stimulate the pathways of coagulation and
fibrinolysis.
Pathophysiology
To understand the events of DIC, a review of the normal homeostatic process may be
beneficial. Hemostasis refers to cessation of bleeding by the physiologic properties of
vasoconstriction and coagulation, often initiated by injury to the blood vessel In a
healthy individual, the normal events of hemostasis (vascular constriction, platelet plug
formation, and coagulation) must be balanced with the mechanism for breaking down
fibrin clots after healing occurs to restore normal blood flow. This is the process of
fibrinolysis
When the body experiences an injury to a blood vessel, muscular response to the injury
causes the vessel to constrict, decreasing blood flow to the area. The blood is exposed
to collagen in the activated vascular endothelium, initiating coagulation. Platelets
respond to the site of injury and become activated, releasing substances such as growth
factor, adenosine diphosphate, prostaglandins, and fibrin-stabilizing factor. They change
their normally smooth surface and shape, and their lipoprotein layer promotes adhesion
and aggregation, forming a platelet plug.
Historically, the clotting cascade has been described as being initiated by either the
intrinsic or the extrinsic pathway, both of which lead to a common pathway that results
in the formation of fibrin. The more recent literature no longer separates the two
pathways, but instead views the overall process. Tissue factor is exposed to factor VII,
converting it to factor VIIa. In the presence of ionized calcium and phospholipid, this
combination activates factor X and factor IX. Factor Xa, along with cofactor Va, is
responsible for converting prothrombin to thrombin, a serine protease with important
coagulation functions. Thrombin splits fibrinogen to form fibrin monomers, soon
converted to fibrin polymers, which, in the presence of factor XIII, forms a stable and
cross-linked fibrin clot. Figure 1 represents the process of coagulation.
Summary
Disseminated intravascular coagulation (DIC) is a disorder of hemostasis that may occur
in the neonatal period as a complication of various other disease processes.
Disseminated intravascular coagulation is a bleeding disorder characterized by two
seemingly opposite conditions. DIC is a condition of uncontrolled bleeding,
simultaneous with uncontrolled clotting, set into motion by an inappropriate activation
and consumption of clotting factors resulting in a hemorrhagic state due to inadequate
hemostasis.
DIC is not a primary diagnosis, but instead a secondary coagulation disorder that
complicates various primary conditions. The blood is exposed to collagen in the
activated vascular endothelium, initiating coagulation. Platelets respond to the site of
injury and become activated, releasing substances such as growth factor, adenosine
diphosphate, prostaglandins, and fibrin-stabilizing factor. Tissue factor is exposed to
factor VII, converting it to factor VIIa. Thrombin splits fibrinogen to form fibrin
monomers, soon converted to fibrin polymers, which, in the presence of factor XIII,
forms a stable and cross-linked fibrin clot.

Reaction

It is needed to intervene immediately to neonates with DIC since this can lead to
mortality to the baby due to rapid blood loss, which is essential to the body. It is always
advisable to pregnant women to seek for prenatal check-ups to avoid certain conditions
such as this and to detect any abnormalities that may put the mother or the baby at
risk. Screening may also help in preventing this disorder. Through screening we may be
able to intervene before the disease has done severe damage and it may also be
properly prevented. Through screening babies will have a greater survival rate.
Complications such as death will be lessened and/or prevented from occurring. DIC may
be a deadly disease but with proper assessment and action these disorders may be
contained and controlled not only for neonates but for everyone else as well.















DONA REMEDIOS TRINIDAD ROMUALDEZ MEDICAL
FOUNDATION
Calanipawan, Tacloban City






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Submitted To:
Ms. Gina Capales R.N.








Submitted By:
Mr. Christian Eduard A. de Dios
BSN II B
Group 5