CASE

A 70-year-old man was admitted to the

hospital because of generalized ecchymoses.
He had been diagnosed with prostate cancer
metastatic to bone 5 years earlier.
Subsequently, he had slowly progressive
disease
He also received radiation therapy to his left
shoulder and to epidural disease in the lower
thoracic spine
Three months before this admission, he
underwent posterolateral decompression and
Within 24 hours of surgery, his platelet count
dropped from 230,000/µL to 69,000/µL, and
his prothrombin time increased to 19.1
seconds (International Normalized Ratio [INR]
= 1.56). He was given packed red cells,
platelets, and fresh frozen plasma, and he
showed improvement in all hematologic
parameters. Five weeks before this admission,
his platelet count was 149,000/µL.
The most striking physical finding on this
admission was multiple large confluent
ecchymoses primarily involving the flanks and
lower extremities
His platelet count was 62,000/µL, and his
prothrombin time was 14.8 seconds (INR =
1.21). The activated partial thromboplastin
time was 32.6 seconds, the serum fibrinogen
was 87 mg/dL. Shortly after admission, the
fibrinogen dropped to 55 mg/dL.
 Overview
Disseminated Intravascular Coagulation
- clinicopathologic syndrome that is not a
specific disease but a manifestation of an
underlying disorder.
- loss of balance between procoagulant and
fibrinolytic capacities.
Types of DIC
1. Acute
2. Chronic

Diagnostic exams
2.Prothrombin Time (11-16 seconds)
3.Prothrombin / International normalized ratio
(1.2 – 2.5 seconds)
3. Activated partial thromboplastin time
(25-38 seconds)
4. Fibrinogen (200 – 400 g/dL)
Manifestations
1. Thrombosis
- petechiae or ecchymoses
2. Hemorrhage
Causes
1. Obstetric conditions
2. Cancers
3. Infections
4. Trauma or surgery
5. Shock
Anatomy and
Physiology
Platelets
Platelets (see fig. 18.1) are not cells but small
fragments of
megakaryocyte cytoplasm. They are 2 to 4 m in
diameter
and possess lysosomes, endoplasmic reticulum,
a Golgi
complex, and Golgi vesicles, or “granules,” that
contain a
variety of factors involved in platelet function.
Events in Hemostasis
1. Vascular constriction
2. Formation of a platelet plug
3. Formation of a blood clot as a result of blood
coagulation
4. Eventual growth of fibrous tissue into the
blood clot to close the hole in the blood
vessel permanently
Lysis of Blood Clots
Plasmin
- Digest fibrin fibers

t-PA

Plasminoge Plasmin
n
Pathophysiology
 Stimulus
Tissue destruction Endothelial Injury

Extrinsic pathways Tissue factor

Factor XII activation
(intrinsic pathway)
Thrombin
generation

Intravascular fibrin Platelet

Plasminogen
deposition consumption
activation

Thrombocytopenia
Plasmin
generation
Thrombosis Clotting factor
Fibrinolysis degradation
RBCs damaged Tissue
ischemia Bleeding
Fibrin degradation
Hemolytic products
anemia (inhibit thrombin and dec circulating
platelet aggregation) blood
dec O2
Organ transportation
Failure Tissue hypoxia
Nursing Problems
1. High Risk for Altered Tissue Perfusion
2. High Risk for Fluid Volume Deficit
3. Impaired Tissue Integrity
Bibliography
Ximelagatran
A promising new oral
anticoagulant
by Lee P. Skrupky and Karen Kopacek , RPh
References
 Wintrobe’s Clinical Hematology 9 th
ed. by
Lee
 Internal Medicine by Jay Stein
 Kelley’s Internal Medicine by H. David
Humes
 Anatomy and Physiology 6th ed. By
Thibodeau & Patton
 Pathophysiology: The Biological Principles of
Disease by Smith & Thier
 Textbook of Medical Physiology by Guyton &
Hall
 Pathophysiology for the Health Professions
3rd ed. by Gould