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Otterbein University

Digital Commons @ Otterbein


Master of Science in Nursing (MSN) Student
Student Research & Creative Work
Scholarship

7-2018

Disseminated Intravascular Coagulation (DIC)


Nicholas A. Brown
Otterbein University, brown1@otterbein.edu

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Recommended Citation
Brown, Nicholas A., "Disseminated Intravascular Coagulation (DIC)" (2018). Master of Science in Nursing (MSN) Student Scholarship.
317.
https://digitalcommons.otterbein.edu/stu_msn/317

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Disseminated Intravascular Coagulation (DIC)
Nicholas Brown, BSN, RN
Otterbein University, Westerville, Ohio
Topic Statement References
Investigation of disseminated Etiology & Signs & Symptoms Significance Implications for Boral, DO, B., Williams, MD, D., & Boral,
MD, MBA, L. (2016). Disseminated
Depends on underlying Though DIC presents in Nursing Care
intravascular coagulation (DIC) in Presentation disease process, and
Intravascular Coagulation. American Journal of
the critical care setting, and how Clinical conditions identified under 20% of ICU Quick and accurate clinical
Clinical Pathology, 146 (6), 670-680.
doi:10.1093/ajcp/aqw195
it contributes to multi-system whether presentation is admissions, Toh et al. (2016) diagnosis is critical, therefore
as etiologies that can lead to
organ failure. acute or chronic shares that “the presence of nurses need to be aware of
Gando, S., Meziani, F., & Levi, M. (2016). What’s
the development of DIC New in the Diagnostic Criteria of
• Result of either DIC increases the chances of what indicators to look for Disseminated Intravascular Coagulation? Intensive
Introduction (McCance et al., 2014, p.
hemorrhage or mortality beyond those of that indicate organ failure.
Care Medicine, 42 (6), 1062-1064.

DIC has been widely 1044): doi:10.1007/s00134-016-4257-z


thrombosis Nurses should assess for:
recognized as a contributing • Sepsis/infection (gram- the primary disease.” This is Lee, MD, D. H., Lee, MD, Ph.D., B. K., Jeung, MD,
• Most common • Changes in LOC, confusion Ph.D., K. W., Jung, MD, Y. H., Lee, MD,
factor in the outcome of positive or gram- why early recognition Is
symptom is bleeding- • Seizure activity S. M., Cho, MD, Y. S., Yun, Ph.D., S.-W., & Min, MD,
several illnesses (Gando, et negative bacteria, essential, and leads to better Ph.D., Y. I. (2017). Disseminated Intravascular
al., 2016), and is typically a from lines and wounds, • Oliguria Coagulation is Associated with the Neurologic
malaria, fungi, viral outcomes for the affected Outcome of Cardiac Arrest Survivors. The American
manifestation of an purpura, petechia, • Hematuria
hemorrhagic fever) patient. Recognition of DIC is Journal of Emergency Medicine, 35 (11), 1617-1623.
underlying pathologic or hematomas, bleeding • Hypoxia doi:10.1016/j.ajem.2017.04.077
• Malignancies (metastatic not an easy task for health
disease process (Boral et al. from eyes, nose, gums • Hypotension Levi, M. (2014). Diagnosis and Treatment of
cancer or acute care providers as the process
(2016). Boral et al. (2016) • Can lead to shock; most • Hemoptysis Disseminated Intravascular Coagulation.
further relays that “DIC is leukemia)
demonstrate bleeding Underlying Pathophysiology has a “dynamic progression” • Chest pain
International Journal of Laboratory Hematology, 36
(3), 228-236. doi:10.1111/ijlh.12221
relatively uncommon in the • Pregnancy complications The pathophysiology of DIC is complex, and “A variety of
from 3 or more and manifests in a variety of • Tachycardia
general hospitalized patient (amniotic fluid Levi, M. (2018). Pathogenesis and Diagnosis of
unrelated sites mechanisms contributing to the derangement of coagulation in ways (Toh et al., 2016). As (McCance et al., 2014, p. 1046) Disseminated Intravascular Coagulation.
but accounts for 9% to 19% of embolism, abruptio International Journal of Laboratory Hematology, 40
ICU admissions and has a high (McCance et al., 2014, p. DIC have been elucidated.” (Levi, 2018). The significance of this the end result of Diagnosis is confusing and (1), 15-20. doi:10.1111/ijlh.12830
placentae, intrauterine process is inherent in the fact that a variety of factors, such as difficult, meaning the bedside
mortality rate of 45% to 78%.” 1046) uncontrolled DIC leads to
fetal demise) endothelial injury and inflammation, can initiate DIC (McCance et nurse plays a critical role in
McCance, K.L., Huether, S.E., Brashers, V.L., & Rote,
To better understand this • Symptoms of organ failure, prompt N.S. (eds.). (2014). Pathophysiology: The Biologic
complex process, it is • Severe trauma (head al., 2014, p. 1045). early identification of Basis for Disease in Adults and Children (7th ed.). St.
thrombosis are not recognition and treatment
important to discuss normal injury, burns, etc.) • Suppression of normal homeostasis symptoms.
Louis, MO: Elsevier/Mosby.
quite as evident- gives patients a better
pathogenesis, and what leads • Liver disease • Tissue factor (TF) release by endothelium or monocytes The nurse must also be Toh, MD, C.-H., Alhamdi, Ph.D., Y., & Abrams, Ph.D.,
determines the degree chance at recovery. The
to the DIC cascade in critically • Immunologic reactions • TF initiates the coagulation cascade, leading to thrombin cognizant of the pertinent lab
S. (2016). Current Pathological and Laboratory
of morbidity and risk of Considerations in the Diagnosis of Disseminated
ill patients. (severe anaphylaxis, activation, production of fibrin, and polymerization in a fibrin
significance of this is that values that drive treatment of Intravascular Coagulation. Annals of Laboratory
Normal hemostasis: death (McCance et al., Medicine, 36 (6), 505-512.
hemolytic transfusion clot (McCance et al., 2014, p. 1045) organ failure most frequently DIC: doi:10.3343/alm.2016.36.6.505
• A localized process 2014, p. 1046)
reactions) • Clot digestion through plasmin activity → fibrin degradation involves the lungs and • Blood component therapy Additional Sources
• Outcome is a platelet • Asymptomatic to life-
plug made through • Vascular abnormalities products kidneys, followed by the based on lab findings Clark, Steven L. (2015). Chapter 31: Disseminated
threatening symptoms- Intravascular Coagulopathy. Retrieved from
platelet adhesion and (giant hemangiomas, • Tumor necrosis factor-α inhibits plasmin generation → brain, heart, liver, spleen, • FFP for INR > 1.5
difficult for nurses to https://obgyn.mhmedical.com/content.aspx?bookid
aggregation large aortic aneurysms) diminished fibrinolysis adrenals, pancreas, and GI • Platelet concentrates for =1580&sectionid=96351365
identify in an acute
• Secondary fibrin clot • Hypoxia • Further induction of cytokine release by monocytes tract (Boral et al., 2016). platelets < 50,000 Medbullets (2018). Disseminated Intravascular
presentation
through activation of the (Levi, 2018) • Coagulation cascade, including thrombin, activates Once the cascade has been • Cryoprecipitate for Coagulation. Retrieved from
coagulation cascade https://step1.medbullets.com/hematology/114067/
fibrinogen < 100 mg/dl disseminated-intravascular-coagulation-dic
• Leads to the formation of inflammatory systems, as well as the kinin and complement initiated, providers struggle
• RBC for hematocrit < 21%
thrombin systems to control and reverse the Schub, E., & Balderrama, D. (2018). Disseminated
(Boral et al., 2016) Intravascular Coagulation (DIC). CINAHL Nursing
(Boral et al., 2016) • Mediators produced affect vascular endothelium → damage it causes to critically Guide.
DIC: increased permeability ill patients.
• Acquired syndrome • Contributes to hypotension and potential shock
characterized by
• Uncontrolled consumption of platelets and clotting factors
intravascular activation
→ potential systemic hemorrhages Conclusion
of coagulation DIC is dynamic and complex, requiring vigilant monitoring from
• No specific localization, • Excess activation of coagulation and platelets → systemic
results from different microvascular thrombosis → blockage of vessels with the bedside nurse. Prompt recognition of the underlying
causes progressive ischemia disease process is critical for successful patient outcomes, as
• Can cause damage to the • Uncontrolled DIC will ultimately lead to multi end-organ there is no one lab test that is used to diagnose DIC (McCance
microvasculature, and failure (McCance et al., 2014, p. 1045) et al., 2014, p. 1047). Presentation can range from acute life-
can lead to organ https://step1.medbullets.com/hematology/114067/dissemin
(Levi, 2018) threatening to stable chronic, so the clinical course will vary
dysfunction ated-intravascular-coagulation-dic
from patient to patient.
(Boral et al., 2016)