3. DEFINITION
• DIC is an acquired syndrome characterized by the
intravascular activation of coagulation with loss of
localization arising from different causes. It can
originate from and cause damage to the
microvasculature, which if sufficiently severe, can
produce organ dysfunction
7. .
Classification
• Acute DIC :It happened rapidly, the
coagulopathy is dominant and major
symptoms are bleeding and shock, mainly
seen in severe infection, amniotic fluid
embolism.
• Chronic DIC: it happened slowly and last
several weeks, thrombosis and clotting may
predominate mainly seen in cancer.
8. Etiology
•
DIC is not a primary disease, but a disorder
secondary to numerous triggering events
such as serious illnesses.
• infectious disease 31%~43%
• (bacterial, viral, parasitic diseases and so on)
Bacterial infection, in particular septicemia, is
commonly associated with DIC.
•
9. Continuo
cancer 24%~34%
(Acute promyelocytic leukemia, acute
myelomonocytic or monocytic leukemia,
disseminated prostatic carcinoma
Lung, breast, gastrointestinal malignancy)
Obstetric complications 4%~12%
amniotic fluid embolus, septic abortion, and so
on)
(
10. Continuo
• severe tissue injury 1%~5%
(burn, heart shock, fracture and so on) Head trauma in
particular is strongly associated with DIC; both local and
systemic activation of coagulation may be detected after
such an event.
systemic disease
(malignant hypertension , Acute respiratory
distress syndrome<ARDS>, hemolytic transfusion
reaction)
11. TESTS
Test
Platelet count
Fibrin degradation
product (FDP)
Factor assay
Prothrombin time (PT)
Activated PTT
Thrombin time
Fibrinogen
D-dimer
Antithrombin
Abnormality
Decreased
Increased
Decreased
Prolonged
Prolonged
Prolonged
Decreased
Increased
Decreased
16. Continuo
• Bleeding :
It may occur at any site, but spontaneous bleeding
and oozing at venipuncture sites or wounds are
important clues to the diagnosis.
• Thrombosis:
It is most commonly manifested by digital
ischemia and gangrene, renal cortical necrosis and
hemorrhagic adrenal infarction may occur.
17.
18. Treatment Modalities
TREATMENT
• Treat the underlying cause
• Provide supportive management of
complications
• Stop abnormal coagulation and control
bleeding by replacement of depleted blood
and clotting components(FFP, Platelets,PRBC)
• Medications can be used and choice depends
on the patient’s condition
(Heparin, Antithrombin III (ATIII), (
Fibrinolytic inhibitors)
19. Nursing Process--Planning the Care of the
Patient With DIC
• Major goals include maintenance of
hemodynamic status, maintenance of intact
skin and oral mucosa, maintenance of fluid
balance, maintenance of tissue perfusion,
enhanced coping, and absence of complications
19
20. Interventions
• Assessment and interventions should target
potential /actual sites of organ damage
• Monitor and assess carefully for bleeding and
thrombosis
• Avoid trauma and procedures that increase the
risk of bleeding, including activities that increase
intracranial pressure
21. References
Otto, Shirley E. (2001). Oncology
Porth, Carol M. (2004). Essentials of
Pathophysiology: Concepts of Altered
Health States. Lippncott Williams &
Wilkins: Philadelphia.
Web Sites:
Pat Bowne, faculty Alverno College Milwaukee Wis.
• Levi M & Ten Cate H. Disseminated intravascular coagulation. N Engl J
Med 341: 586 - 592, 1999.
