Disseminated intravascular coagulation (DIC) is a coagulation disorder that prompts overstimulation of the normal clotting cascade and results in simultaneous thrombosis and hemorrhage. The formation of microclots affects tissue perfusion in the major organs, causing hypoxia, ischemia, and tissue damage. Coagulation occurs in two different pathways: intrinsic and extrinsic. These pathways are responsible for the formation of fibrin clots and blood clotting, which maintains homeostasis. In the intrinsic pathway, endothelial cell damage commonly occurs because of sepsis or infection. The extrinsic pathway is initiated by tissue injury such as from malignancy, trauma, or obstetrical complications. DIC may present as an acute or chronic condition.
An essential medical management of DIC is primarily aimed at treating the underlying cause, managing complications from both primary and secondary cause, supporting organ function, and stopping abnormal coagulation and controlling bleeding. Morbidity and mortality depend on underlying cause and severity of coagulopathy.
What are the symptoms of DIC?
Bleeding, sometimes from multiple locations on the body, is one of the more common symptoms of DIC. Bleeding from the mucosal tissue (in the mouth and nose) and other external areas may occur. In addition, DIC may cause internal bleeding.
What Are the Signs and Symptoms of Disseminated Intravascular Coagulation?
Signs and symptoms of disseminated intravascular coagulation (DIC) depend on its cause and whether the condition is acute or chronic.
Acute DIC develops quickly (over hours or days) and is very serious. Chronic DIC develops more slowly (over weeks or months). It lasts longer and usually isn’t recognized as quickly as acute DIC.
With acute DIC, blood clotting in the blood vessels usually occurs first, followed by bleeding. However, bleeding may be the first obvious sign. Serious bleeding can occur very quickly after developing acute DIC. Thus, emergency treatment in a hospital is needed.
Blood clotting also occurs with chronic DIC, but it usually doesn’t lead to bleeding. Sometimes chronic DIC has no signs or symptoms.
Signs and Symptoms of Excessive Blood Clotting
In DIC, blood clots form throughout the body’s small blood vessels. These blood clots can reduce or block blood flow through the blood vessels. This can cause the following signs and symptoms:
- Chest pain and shortness of breath if blood clots form in the blood vessels in your lungs and heart.
- Pain, redness, warmth, and swelling in the lower leg if blood clots form in the deep veins of your leg.
- Headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking and understanding if blood clots form in the blood vessels in your brain. These signs and symptoms may indicate a stroke.
- Heart attack and lung and kidney problems if blood clots lodge in your heart, lungs, or kidneys. These organs may even begin to fail.
Signs and Symptoms of Bleeding
In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal and external bleeding.
Internal bleeding can occur in your body’s organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:
- Blood in your urine from bleeding in your kidneys or bladder.
- Blood in your stools from bleeding in your intestines or stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.)
- Headaches, double vision, seizures, and other symptoms from bleeding in your brain.
External bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa. (The mucosa is the tissue that lines some organs and body cavities, such as your nose and mouth.)
External bleeding may cause purpura (PURR-purr-ah) or petechiae (peh-TEE-key-ay). Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin.
Other signs of external bleeding include:
- Prolonged bleeding, even from minor cuts.
- Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from brushing your teeth.
- Heavy or extended menstrual bleeding in women.
Other symptoms are:
Decreased blood pressure
Rectal or vaginal bleeding
Red dots on the surface of the skin (petechiae)
If you have cancer, DIC generally begins slowly, and clotting in the veins is more common than excessive bleeding.
What causes DIC?
When the proteins used in your normal clotting process become overly active, it can cause DIC. Infection, severe trauma (such as brain injuries or crushing injuries), inflammation, surgery, and cancer are all known to contribute to this condition.
Some less common causes of DIC include the following:
- Extremely low body temperature (hypothermia)
- Venomous snake bites
- Complications during pregnancy
- You may also develop DIC if you go into shock.
- Who is at risk for DIC?
Your risk for DIC is elevated if you have recently:
- Undergone surgery
- Delivered a baby
- Had an incomplete miscarriage
- Had a blood transfusion
- Had anesthesia
- Had sepsis or any other fungal or bacterial blood infection
- Had certain types of cancer, especially certain types of leukemia
- Had serious tissue damage such as a head injury, burns, or trauma
- Had liver disease
How is DIC diagnosed?
DIC may be identified through various tests related to your levels of platelets, clotting factors, and other blood components. However, there isn’t a standard procedure. The following are some tests that may be conducted if your doctor suspects DIC:
- Fibrin degradation product
- Complete blood cell count from a blood smear
- Complete blood cell count from a sample
- Platelet count
- Partial thromboplastin time
- D-dimer test
- Serum fibrinogen
- prothrombin time
Complications of DIC
DIC can cause complications, especially when it isn’t treated properly. Complications can occur from both the excessive clotting that happens in the early stages of the condition and the absence of clotting factors in the later stages. Complications include:
- Blood clots that cause a lack of oxygen to limbs and organs
- Excessive bleeding that may lead to death
How is DIC treated?
DIC treatment depends on what is causing the disorder. Treatment of the underlying cause is the main goal. To treat the clotting problem, you may be given an anticoagulant called heparin to reduce and prevent clotting. However, heparin may not be administered if you have a severe lack of platelets or are bleeding too excessively.
People with acute (sudden) DIC require hospitalization, often in an intensive care unit (ICU), where treatment will attempt to correct the problem causing the DIC while maintaining the function of the organs.
A transfusion may be needed to replace the platelets that you are missing. Plasma transfusions have the ability to replace the clotting factors that you’re lacking.
Long-term outlook for DIC
The outlook of your treatment depends on what caused you to develop DIC. If the initial problem can be corrected, then DIC will resolve. If not, your doctor may prescribe blood thinners to prevent blood clots.
People who are taking blood thinners should see their doctors for regular checkups. Your doctor will want to give you regular blood tests to evaluate how your blood is clotting.
The following are the common nursing care planning and goals for clients with DIC: maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, prevention of complications.
Here are four (4) nursing care plans (NCP) and nursing diagnosis for patients with disseminated intravascular coagulation:
Impaired Gas Exchange
May be related to
- Altered oxygen-carrying capacity of blood
Possibly evidenced by
- Abnormal arterial blood gases (ABGs)
- Abnormal breathing (rate, depth, and rhythm)
- Client will maintain optimal gas exchange, as evidenced by ABGs within client’s usual range; oxygen saturation of 90% or greater; alert, responsive mentation or no further reduction in the level of consciousness; and relaxed breathing and baseline HR for the client.
|Assess for changes in the level of consciousness.||Early signs of cerebral hypoxia are restlessness and irritability; later signs are confusion and somnolence.|
|Assess the respiratory depth, rate, and rhythm.||The client will adapt breathing patterns over time to facilitate gas exchange. Rapid, shallow respirations may result from hypoxia or from the acidosis with the shock state. The development of hypoventilation indicates that immediate ventilator support is needed.|
|Assess the client’s breath sounds. Assess cough for signs of bloody sputum.||Changes in breath sounds may reveal the cause of impaired gas exchange. Hemoptysis is an indication of bleeding in the respiratory tract.|
|Assess for tachycardia, shortness of breath, and use of accessory muscles.||These signify an increased work of breathing. With initial hypoxia, HR increases. The use of accessory muscles increases chest excursion to facilitate effective breathing.|
|Monitor oxygen saturation and assess arterial blood gases (ABGs).||Pulse oximetry is a useful tool to detect early changes in oxygen saturation. Oxygen saturation should be kept at 90% or greater. Increasing PaCo2 and decreasing PaO2 are signs of hypoxemia and respiratory acidosis.|
|Provide reassurance and allay anxiety by staying with the client during the acute episodes of respiratory distress.||Anxiety increases dyspnea, the work of breathing, and the respiratory rate.|
|Change the client’s positioning every 2hours, and perform chest physiotherapy.||These maneuvers facilitate the movement and drainage of secretions.|
|Position the client in a high-Fowler’s position as indicated.||An upright position allows for adequate diaphragmatic and lung excursion and promotes optimal lung expansion.|
|Assist with coughing or suction as indicated.||Productive coughing is the most effective way to remove moist secretions. If the client is unable to perform independently, suctioning may be needed to promote airway patency and reduce the work of breathing.|
|Maintain an oxygen administration device as ordered.||The appropriate amount of oxygen must be delivered continuously so that the client maintains an oxygen saturation of 90% or greater.|
|Anticipate the need for intubation and mechanical ventilation.||Early intubation and mechanical ventilation are recommended to prevent full decompensation of the client. Mechanical ventilation provides supportive care to maintain adequate oxygenation and ventilation to the client.|
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