Disseminated Intravascular Coagulation

University Duhok faculty of medical science school of nursing

Prepared by:Sirwan HamabaqiChnar SabrShadan AbdulstarPayam Nuri

Supervisor: Mr.Rasoul S.piro

• Definition• Pathophysiology• Classification• Etiology• Tests• Clinical manifestation of DIC• Complication • Treatment• Nursing Process• Reference

CONTAIN…

• DIC is an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes. It can originate from and cause damage to the microvasculature, which if sufficiently severe, can produce organ dysfunction

DEFINITION

Disseminated Intravascular Coagulation

Coagulation Anticoagulation

Balance

Coagulation Fibrinolysis

Exposure of blood to procoagulant substances

Secondary fibrinolysis（ FDP formation）

widespread thrombosis systemic hemorrhagic syndrome

Clotting factors & Platelet depletion

Coagulation Fibrinolysis

SYSTEMIC ACTIVATION OF COAGULATION

Intravascular

deposition of fibrin

Depletion of platelets

and coagulation

factors

Thrombosis of small

and midsize vessels

Bleeding

Organ failure

DEATH

Pathophysiology

• Acute DIC :It happened rapidly, the coagulopathy is dominant and major symptoms are bleeding and shock, mainly seen in severe infection, amniotic fluid embolism.

• Chronic DIC: it happened slowly and last several weeks, thrombosis and clotting may predominate mainly seen in cancer.

Classification.

• DIC is not a primary disease, but a disorder secondary to numerous triggering events such as serious illnesses.

• infectious disease 31%~43%• (bacterial, viral, parasitic diseases and so on)

Bacterial infection, in particular septicemia, is commonly associated with DIC.

Etiology

cancer 24%~34% (Acute promyelocytic leukemia, acute myelomonocytic or monocytic leukemia, disseminated prostatic carcinomaLung, breast, gastrointestinal malignancy)

Obstetric complications 4%~12%(amniotic fluid embolus, septic abortion, and so on)

Continuo

• severe tissue injury 1%~5% (burn, heart shock, fracture and so on) Head trauma in

particular is strongly associated with DIC; both local and systemic activation of coagulation may be detected after such an event.

systemic disease (malignant hypertension , Acute respiratory distress syndrome<ARDS>, hemolytic transfusion reaction)

Continuo

TestPlatelet count Fibrin degradation product

(FDP)Factor assayProthrombin time (PT)Activated PTTThrombin timeFibrinogenD-dimerAntithrombin

AbnormalityDecreased Increased

DecreasedProlongedProlongedProlongedDecreasedIncreasedDecreased

TESTS

ORGAN ISCHEMIC HEMOR.Skin Pur. Fulminans

GangreneAcral cyanosis

PetechiaeEchymosisOozing

CNS Delirium/ComaInfarcts

Intracranialbleeding

Renal Oliguria/AzotemiaCortical Necrosis

Hematuria

Cardiovascular MyocardialDysfxn

Pulmonary Dyspnea/HypoxiaInfarct

Hemorrhagiclung

GIEndocrine

Ulcers, InfarctsAdrenal infarcts

Massivehemorrhage.

Clinical Manifestations of DIC

Symptoms and Signs

BleedingThrombosisHypotension or shockOrgan dysfunction

COMPLICATION

• Bleeding : It may occur at any site, but spontaneous bleeding

and oozing at venipuncture sites or wounds are important clues to the diagnosis.

• Thrombosis: It is most commonly manifested by digital ischemia and gangrene, renal cortical necrosis and hemorrhagic adrenal infarction may occur.

Continuo

Treatment Modalities

• Treat the underlying cause• Provide supportive management of

complications• Stop abnormal coagulation and control

bleeding by replacement of depleted blood and clotting components(FFP, Platelets,PRBC)

• Medications can be used and choice depends on the patient’s condition (Heparin, Antithrombin III (ATIII), ( Fibrinolytic inhibitors)

TREATMENT

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• Major goals include maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, enhanced coping, and absence of complications

Nursing Process--Planning the Care of the Patient With DIC

• Assessment and interventions should target potential /actual sites of organ damage

• Monitor and assess carefully for bleeding and thrombosis

• Avoid trauma and procedures that increase the risk of bleeding, including activities that increase intracranial pressure

Interventions

Otto, Shirley E. (2001). Oncology Porth, Carol M. (2004). Essentials of

Pathophysiology: Concepts of AlteredHealth States. Lippncott Williams &Wilkins: Philadelphia.

Web Sites:Pat Bowne, faculty Alverno College Milwaukee Wis.

• Levi M & Ten Cate H. Disseminated intravascular coagulation. N Engl J Med 341: 586 - 592, 1999.

References

THE END

Thank you!!!