Disseminated

Intravascular
Coagulation (DIC)
Santos, Maria Ericka B.
BSN III

WHAT IS DIC?
Disseminated Intravascular Coagulation (DIC), formerly
termed disseminated intravascular coagulopathy, is not a
disease but a sign of an underlying condition. The severity of
DIC is variable, but it is potentially life-threatening. (Brunner
& Suddarths Textbook of Medical-Surgical Nursing, 11 th ed)
A paradox in the hemostatic sequence and is characterized
by widespread coagulation and bleeding in the vascular
compartment. (Essentials of Pathophysiology 2 nd ed, Carol
Porth)

ASSESSMENT OF CLIENTS WITH

DIC:
During initial process of DIC, the patient may have no new symptoms,
the only manifestation being a progressive decrease in platelet count.
As thrombosis becomes more extensive, the patient exhibits signs and
symptoms of thrombosis in the organs involved. Then, as the clotting
factors and platelets are consumed to form these thrombi, bleeding
occurs.
Patients with frank DIC may bleed from mucous membranes,
venepuncture sites, and the G.I. and urinary tracts. The bleeding can
range from minimal occult internal bleeding to profuse haemorrhage
from all orifices.

Nurses need to be aware of which patients are

at risk of DIC. Sepsis and acute promyelocytic
leukemia are the most common causes of DIC.
Patients need to be assessed thoroughly and
frequently for signs and symptoms of thrombi
and bleeding and monitored for any
progression of these signs.

CONDITIONS THAT HAVE BEEN ASSOCIATED WITH DIC:

Obstetric Conditions:

Shock:

Abruptio Placentae

Septic Shock

Dead Fetus Syndrome

Severe hypovolemic shock

Preeclampsia and Eclampsia

Trauma or Surgery:

Amiotic Fluid Embolism

Burns

Cancers:

Massive trauma

Metastatic Cancer

Surgery involving extracorporeal

circulation

Lekemia

Snake bite

Infections:

Heatstroke

Acute bacterial infections (e.g.

meningococcal meningitis)

Hematologic Conditions:

Acute Viral Infections

Blood transfusion reactions

Rickettsial infection
Parasitic infection

ASSESSING FOR RECOGNIZING THROMBOSIS AND

BLEEDING IN DISSEMINATED INTRAVASCULAR
COAGULATION (DIC)
SYSTEM

SIGNS AND SYMPTOMS OF

MICROVASCULARTHROMBOSIS

SIGNS AND SYMPTOMS OF

MICROVASCULAR AND FRANK BLEEDING

Integument
ary system
(skin)

Temperature, sensation; pain;

cyanosis in extremities, nose,
ear- lobes; focal ischemia,
superficial gangrene

Petechiae, including periorbital and oral

mucosa; bleeding: gums, oozing from
wounds, previous injection sites, around
catheters (IVs, tracheostomies); epistaxis;
diffuse ecchymoses; subcutaneous
hemorrhage; joint pain

Circulatory
system
Respiratory
system

Pulses; capillary filling time > 3

sec., Hypoxia (secondary to clot
in lung); dyspnea; chest pain
with deep inspiration; breath
sounds over areas of large
embolism

Tachycardia High-pitched bronchial breath

sounds; tachypnea; consolidation; signs
and symptoms of acute respiratory
distress syndrome

SYSTEM

SIGNS AND SYMPTOMS OF

MICROVASCULARTHROMBOSIS

SIGNS AND SYMPTOMS OF

MICROVASCULAR AND FRANK
BLEEDING

Gastrointesti Gastric pain; "heartburn"

nal
system

Hematemesis (heme+ NG output)

melena (heme stools > tarry
stools > bright-red blood from
rectum) retroperitoneal bleeding
(abdomen firm and tender to
palpation; distended abdominal
girth)

Renal
system

Urine output; creatinine, blood

urea nitrogen

Hematuria

Neurologic
system

Alertness and orientation;

pupillary reaction; response to
commands; strength and
movement ability

Anxiety; restlessness; mentation,

altered level of consciousness; headache;
visual disturbances; conjunctival
hemorrhage

DIAGNOSTIC AND
LABORATORY
PROCEDURES OF CLIENTS
WITH DIC

Medical History and Physical Exam

Complete Blood Count and Blood
Smear
Tests for Clotting Factors and Clotting
Time

PATHOPHYSIOLO
GY
OF DIC

MEDICAL
MANAGEMENT
Objectives of treatment:
There is no specific treatment for DIC. The most
important management factor in DIC is treating the
underlying cause; until the cause is controlled, the DIC will
persist. Thus, infection will need antibiotics, and obstetric
complications may need intervention

 Correcting the secondary effects of tissue

ischemia
-

Improving oxygenation
Replacing fluids
Correcting Electrolyte imbalances
Administering vasopressor medications

If serious hemorrhage occurs

Depleted coagulation factors and platelets may be replaced to reestablish the potential for formal hemostasis and thereby diminish
bleeding.
- Cryoprecipitate is given to replace fibrinogen and factors V and
VII. Severe hypofibrinogenaemia (<1 g/L)
- In bleeding patients with DIC and prolonged PT and aPTT,
administration of fresh frozen plasma (FFP) may be useful. It
should not be started only on laboratory tests alone but should be
considered in those with active bleeding and in those requiring an
invasive procedure.

 If transfusion of FFP is not possible in patients with bleeding

because of fluid overload, factor concentrates such as
prothrombin complex concentrate should be considered
(these will only partially correct the defect because they
contain only selected factors, whereas DIC involves a global
deficiency of coagulation factors).

To interrupt the thrombosis process

- Heparin Infusion
Heparin may inhibit the formation of microthrombi and
thus permit perfusion of the organs (skin, kidneys, or
brain) to resume.
Heparin use was traditionally reserved for patient in whom
thrombotic manifestations predominated or in whome
extensive blood component replacement failed to halt the
hemorrhage or increased fibrogen and other clotting

 Effectiveness of Heparin can be best determined by

observing normalization of the plasma fribrinogen
concentration and diminishing signs of bleeding.
- Fibrinolytic inhibitors, such as aminocaproic acid may
be used with heparin.

Other therapies include

- Recombinant activated protein C
Effective in diminishing inflammatory responses on the
surface of vessels as well as having anticoagulant
properties
Patients with severe sepsis and DIC may be treated with
recombinant human activated protein C by continuous
infusion.
Patients at high risk of bleeding should not be given

- Antithrombin (AT) infusions

Can also be used for their anticoagulant and antiinflammatory properties.

Bleeding can be significant, particularly when
administered in association with heparin.

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