Disseminated intravascular coagulation

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1. Disseminated intravascular coagulation RATHEESH R.L

2. Disseminated intravascular coagulation  ( DIC ), also known as  disseminated intravascular coagulopathy  , is a pathological process characterized by the widespread activation of the  clotting  cascade that results in the formation of blood clots in the  small blood vessels  throughout the body.

3. etiology Acute DIC Sub acute DIC Chronic DIC

4. Acute DIc Septicemia Hemolytic processes * Transfusion of mismatched blood * Acute hemolysis from infection * Amniotic fluid embolism * Septic abortion Malignancies * Acute leukemia * Lymphoma

5. Acute Dic … Tissue damage * Extensive burns and trauma * Severe head injury * Transplant rejections * Snake bite * Glomerulonephritis

6. Sub acute DIC Malignant disease * Myeloproliferative malignancies * Metastatic cancer Obstetric * Retained dead fetus

7. Chronic dic Liver disease Systemic lupus erythematosus Localized malignancy

8. pathophysiology Etiologic factors Normal coagulation mechanism gets enhanced Abundant intravascular thrombin is produced Catalyses the conversion of fibrinogen to fibrin and enhances platelet aggregation Wide spread fibrin and platelet deposition in capillaries and arterioles

9. pathophysiology Thrombosis Multiorgan failure Clotting inhibitory mechanisms such as anti thrombin III and protein C are depressed Excesssive clotting activates the fibrinolytic system Breaks down the newly formed clot

10. pathophysiology creating fibrin split products Inhibit normal blood clotting Accumulation of fibrin split products and decreased clotting factors Blood loses its ability to clot Predispose the patient to hemorrhage

11. Clinical manifestations Bleeding manifestations Thrombotic manifestations

12. Bleeding manifestations Result from depletion of platelets and coagulation factors as well as clot lysis and formation of fibrin split products Respiratory: Tachypnea , Hemoptysis , orthopnea Cardiovascular : Tachycardia, Hypotension GI : Upper and lower GI bleeding, abdominal distension, bloody stools GU : Hematuria

13. Bleeding manifestations Neurologic changes: vision changes, dizziness, headache, changes in mental status, irritability Musculoskeletal : Bone and joint pain

14. Thrombotic manifestations Result of fibrin or platelet deposition in the microvasculature Integumentary : Cyanosis, Ischemic tissue necrosis, hemorrhagic necrosis Respiratory: Tachypnea , dyspnea , pulmonary emboli, acute respiratory distress syndrome

15. Cardiovascular: Venous distension GI : Abdominal pain, paralytic ileus Renal: kidney damage, oliguria kidney failure

16. Diagnostic measures History collection and physical examination Blood studies Bone marrow aspiration and biopsy ultrasound

17. Blood studies Prothrombin time : prolonged Partial thromboplastin time : prolonged Thrombin time : prolonged Fibrinogen : reduced Platelets : reduced

18. Fibrin split products : elevated Factor assays (V, VII, VIII, X, XIII) : reduced D- Dimers : elevated Protein S: reduced Protein C : reduced Blood smear examination : fragmented erythrocytes

19. management Platelet and plasma transfusion Coagulation factor concentrates such as prothrombin complex Repeated measurements of activated partial thromboplastin time and prothrombin time

20. Anticoagulant therapy * heparin * anti thrombin III * hirudin * epsilon amino caproic acid

21. NURSING MANAGEMENT Monitor vital signs Assess and document the extent of hemorrhage and thrombosis Correct hypovolemia Administer basic hemostatic procedures when indicated Provide psychological support

22. Nursing diagnosis Ineffective tissue perfusion related to bleeding and diminished blood flow Deficient fluid volume related to active fluid volume loss( hemorrhage) Impaired oral mucous membrane related to low platelet count

23. Anxiety related to change in the health status, threat of death Deficient knowledge regarding disease process, treatments, self care and discharge needs related to lack of previous exposure