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Disseminated Intravascular Coagulopathy (DIC) - Coggle Diagram
Disseminated Intravascular Coagulopathy (DIC)
Definition of DIC
DIC is a disorder of hemostasis characterized by excessive microvascular coagulation, depletion of clotting factors, and subsequent bleeding.
It is also known as consumption coagulopathy, as clotting factors are used up in abnormal coagulation, leading to bleeding elsewhere.
Pathophysiology
Widespread clot formation occurs in small vessels, consuming platelets and clotting factors.
As clotting factors are depleted, the body becomes unable to form clots where necessary, leading to widespread bleeding.
Systemic inflammation further exacerbates clotting and bleeding abnormalities, increasing the risk of organ failure and shock.
Causes and Risk Factors
DIC can be triggered by multiple conditions, including:
Infections and sepsis
Trauma and burns
Hematological disorders (hemolytic transfusion reactions, sickle cell crisis)
Cancer (leukemias, tumors)
Obstetric complications (abruptio placentae, amniotic fluid embolism)
Severe liver disease, pancreatitis, or prolonged cardiac bypass surgery.
Clinical Manifestations
Signs of Organ Ischemia:
Confusion, angina, hypoxia, hypotension, oliguria, cyanosis, limb infarction.
Signs of Bleeding:
Occult blood in stool, hematuria, mucosal bleeding (gingival bleeding, petechiae, ecchymoses), and widespread hemorrhage.
Laboratory Findings
Prolonged PT and a PTT (clotting times)
Elevated D-dimer (marker of fibrinolysis)
Low fibrinogen levels
Thrombocytopenia (low platelet count)
Schistocytes (fragmented RBCs) on a blood smear.
Diagnosis of DIC
Diagnosis is based on clinical presentation, risk factors, and laboratory findings.
Scoring systems (such as the ISTH DIC score) help confirm DIC severity and guide treatment.
Treatment: Managing the Underlying Cause
Control the primary trigger (treat sepsis, remove necrotic tissue, deliver the fetus in obstetric DIC).
Supportive therapy to stabilize the patient (IV fluids, blood pressure support).
Blood Product Replacement Therapy
Platelet transfusions for severe thrombocytopenia.
Fresh frozen plasma (FFP) to replace clotting factors.
Cryoprecipitate to replenish fibrinogen and factor VIII.
Packed RBCs to maintain oxygen delivery.
Bleeding precautions: Avoid invasive procedures, apply pressure to puncture sites, and use soft toothbrushes.
Pain control and skin integrity: Prevent pressure ulcers and assess frequently for petechiae or ecchymoses.
Anticoagulation and Pharmacologic Management
Heparin may be used in chronic DIC with thrombosis, but it is controversial in acute bleeding.
Vitamin K is given to enhance clotting factor production.
Antifibrinolytics (tranexamic acid, aminocaproic acid) may be used in specific cases.
Nursing Interventions and Monitoring
Oxygenation and ventilation: Monitor pulse oximetry, administer oxygen, and use incentive spirometry.
Circulation and perfusion: Monitor vital signs, capillary refill, and urine output.