Disseminated Intravascular Coagulation (DIC)

Disseminated intravascular coagulation (DIC), formerly termed disseminated intravascular

coagulopathy is not a disease but a sign of an underlying condition. DIC may be triggered by
sepsis, trauma, cancer, shock, abruptio placentae, toxins, or allergic reactions.

Pathophysiology

Stimulus

Tissue Endothelial
injury
destruction Endotoxin
Tissue factor
(Extrinsic pathway) Endotoxin

Thrombin
Factor XII activation
generation (intrinsic pathway)

Intravascular Plasminogen Platelet

Fibrin deposition activitation comsumption

Plasmin Thrombocytopenia
generation
Clotting factor
Fibrinolysis degradation

Thrombosis
Fibrin degradation
products Bleeding
Hemolytic Tissue (inhibit thrombin
anemia ischemia and platelet aggregation)

Clinical Manifestation and Signs & Symptoms

Patients with frank DIC may bleed from mucous membranes, venipuncture sites, and
the GI and urinary tracts. The patient may also develop organ dysfunction, such as renal failure
and pulmonary and multifocal central nervous system infarctions, as a result of
microthromboses, macrothromboses, or hemorrhages. During the initial process of DIC, the
patient may have no new symptoms, the only manifestation being a progressive decrease in the
platelet count.
Signs&Symptoms:

Bleeding on multiple sites in the body. Uncontrolled bleeding from puncture sites from
injections or IV therapy.
Blood clots. Ecchymoses and petechiae form on the skin.
Drop in BP
Sudden bruising
The toes and fingers are pale, cyanotic or mottled and feels cold.

Assessment and Diagnostic Findings

Various underlying clinical conditions can have an effect on the laboratory parameters that are
usually obtained to diagnose DIC, such as global coagulation tests, the platelet count,
prothrombin time (PT), and the fibrinogen, fibrinogen, and fibrin degradation products (FDPs).
In order to facilitate the diagnostic process for detecting DIC, the use of a scoring system is
recommended by each of the four different guidelines. Global coagulation tests provide
important evidence regarding the degree of coagulation factor activation and consumption.

Medical Management

The most important management factor in DIC is treating the underlying cause; until the cause
is controlled, the DIC will persist. Correcting the secondary effects of tissue ischemia by
improving oxygenation, replacing fluids, correcting electrolyte imbalances, and administering
vasopressor medications is also important. Cryoprecipitate is given to replace fibrinogen and
factors V and VII; fresh frozen plasma is administered to replace other coagulation factors.

Nursing Management

Primary nursing provides the consistency and comprehensive care required in this rapidly
changing condition. Nursing priorities include the following:

Support vital organ functions

Assist with measures to correct the abnormal coagulopathy
Prevent or minimize complications
Promote comfort
Provide emotional support to the patient and significant others.