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Objectives The learner will be able to: • Outline the pathophysiology of DIC and the resulting complications. • Describe management strategies for DIC.
DIC Description DIC is a bleeding disorder caused by a tendency to clot. • A triggering factor produces damage to the small blood vessels of the body. • The damage stimulates the coagulation pathways to form clots. • The formation of clots depletes platelets and clotting factors.
Acute DIC • Develops rapidly (within hours or days) • Intrinsic pathway initiation by endothelial cell damage • Excessive blood clotting in small vessels • Quickly leads to serious bleeding
Acute DIC: Symptoms • Bleeding from at least three unrelated sites • Ecchymosis, bleeding, and hemorrhage • Anxiety and restlessness • Hypoxia and dyspnea • Abdominal pain • Thrombus formation • Focal ischemia, acral cyanosis, and superficial gangrene • Cerebral bleeds and change in mental status
Chronic DIC • Extrinsic pathway initiated by tissue damage • Generally malignancy-related
Chronic DIC: Symptoms • Petechiae • Ecchymosis • Gingival bleeding • Minor GI bleeding • Thrombosis • Small cerebral bleeds
DIC: Risk Factors DIC is always secondary to an underlying disorder. • Acute leukemia, especially APL • Infection and sepsis • Transfusion reactions • Liver disease
DIC: Lab Findings • Increased prothrombin time (PT) • Decreased platelets • Decreased fibrinogen
DIC: Management • Treatment of underlying cause • Fluid replacement • Blood products • FFP • Platelets • PRBCs • Management of clotting • Plasmapheresis • Heparin • Management of bleeding • Aminocaproic acid • Antithrombin III
DIC: Nursing Care Nursing assessment is critical. • Hemodynamic status • Oxygenation • Fluid status • Signs of bleeding or thrombosis • Tissue perfusion • Anxiety
DIC: Patient Education • Teach strategies to prevent or minimize the risk of bleeding. • Review safety precautions. • Avoid taking medications that could interfere with platelet function.
References Ezzone, S.A. (2006). Disseminated intravascular coagulation. In M. Kaplan (Ed.), Understanding and managing oncologic emergencies: A resource for nurses. Pittsburgh, PA: Oncology Nursing Society. Kimmel, T. (2003). Disseminated intravascular coagulation. Clinical Journal of Oncology Nursing, 7, 479481.