Disseminated Intravascular Coagulation (DIC)

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Oxygen Carrying Red Blood Cells
Oxygen Carrying Red Blood Cells

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What is Disseminated Intravascular Coagulation (DIC) ?

Definition

Disseminated vascular coagulation is also called as consumptive coagulopathy where in the blood clotting mechanism happens in response to a variety of disease. This activation is pathological because it leads to formation of small blood clots inside the blood vessels throughout the body consuming the proteins and platelets which is not done in normal coagulation.

Disseminated Intravascular Coagulation Causes

In consumptive coagulopathy, age and gender is not an issue because it can happen to anyone whether young or old. These problems may be due to the following causes:

  1. Sepsis or severe infection
  2. Neurotrauma or trauma
  3. Malignancy
  4. Organ destructions
  5. Rheumatologic illnesses like Lupus and adults Stills disease
  6. Obstetric complications such as amniotic fluid embolism, hemolysis, retained dead fetus syndrome, abruption placenta
  7. Vascular abnormalities such as Large vascular aneurysms
  8. Hepatic conditions that is very severe
  9. Toxic reactions such as transfusion reactions and transplant rejections.
  10. Burns
  11. Hemolytic reactions

Disseminated Intravascular Coagulation Symptoms

Since this is a vascular problem it signs and symptoms will affect the whole body system. Symptoms may include:

  • Epistaxis or nosebleed
  • Gingival bleeding
  • Cough
  • Dyspnea
  • Confusion and disorientation
  • Bruising and petichiae
  • Cough and mucosal bleeding.

Disseminated Intravascular Coagulation Pathophysiology

There are four primary mechanisms primarily responsible for hematologic derangement. These are the increased thrombin generation, suppression of anticoagulant pathways, impaired fribrinolysis and inflammatory activation. Intrinsic clotting pathway is a great factor in the activation of the intravascular coagulation.

The normal homeostatic mechanisms are altered so that a massive amount of tiny clots forms in the microcirculation. Initially, the coagulation time is normal. But as the platelets and the clotting factors are consumed to form the microthrombi, the coagulation fails. It then results to excessive bleeding.

There are many anticoagulation mechanisms that are disabled by consumptive coagulopathy. The tissue factor pathway inhibitor is one of them. At first, the TFPI or the tissue factor pathway inhibitor is normal in patients with sepsis, but after that, DIC is evident.  Also the intravascular fibrin which is produced by the thrombin is eliminated and it is called fibrinolysis. Although the first action to inflammation is the augmentation of fibrinolytic action, the response will soon be reversed and the fibrinolysis is released.

Disseminated Intravascular Coagulation Diagnosis

There are many diagnostic tests done such as:

Blood samples

  • PT and APTT in cases of severe hemorrhage, it is prolonged and high
  • The serum fibrinogen is low
  • Platelet count is low

A biliateral prihilar soft density chest radiograph is done when injury to the pulmonary area is present.

Disseminated Intravascular Coagulation Treatment

In treating the problem the highest priority is to treat the underlying cause of disseminated intravascular coagulation. Until the cause is controlled, the mechanism is always present.

Next goal is the correction of the secondary effects of tissue ischemia by improving oxygenation, replacing fluids, correcting electrolyte imbalances and administering  vassopressor medications.

Cryoprecipitate is given to replace fibrinogen and factors V and VII; fresh frozen plasma is administered to replace the coagulate problem.

There is a controversial method to interrupt the thrombosis process of the use of heparin infusion. The heparin can inhibit the formation of microthrombi and thus permit perfusion of the organs such as skin, kidney or brain to resume. When heparin is injected, the bleeding may actually worsen initially until the thrombotic process is interrupted. The effectiveness of this drug is best determined by the normalization of the plasma fibrinogen concentration and diminishing signs of bleeding.

References

http://www.nlm.nih.gov/medlineplus/ency/article/000573.htm

http://en.wikipedia.org/wiki/Disseminated_intravascular_coagulation

http://emedicine.medscape.com/article/779097-treatment

Medical-Surgical Nursing 10th edition by Suzanne Smeltzer and Brenda Bare

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