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- 1. University Duhok faculty ofmedical science school of nursing Disseminated Intravascular Coagulation Prepared by: Sirwan Hamabaqi Chnar Sabr Shadan Abdulstar Payam Nuri Supervisor: Mr.Rasoul S.piro
- 2. CONTAIN… • • • • • • • • • • Definition Pathophysiology Classification Etiology Tests Clinical manifestation ofDIC Complication Treatment Nursing Process Reference
- 3. DEFINITION • DIC isan 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
- 4. Coagulation Exposure of blood toprocoagulant substances Anticoagulation Balance Clotting factors & Platelet depletion Secondary fibrinolysis （FDP formation） Coagulation Fibrinolysis Coagulation Fibrinolysis widespread thrombosis systemic hemorrhagic syndrome Disseminated Intravascular Coagulation
- 5. SYSTEMIC ACTIVATION OF COAGULATION Intravasc ular depositio nof fibrin Thrombosis of small and midsize vessels Organ failure Depletion of platelets and coagulation factors Bleeding DEATH
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- 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 nota 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 promyelocyticleukemia, 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 tissueinjury 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
- 12. Clinical Manifestations ofDIC ORGAN Skin CNS Renal Cardiovascular Pulmonary GI Endocrine ISCHEMIC HEMOR. Pur. Fulminans Gangrene Acral cyanosis Delirium/Coma Infarcts Oliguria/Azotemia Cortical Necrosis Myocardial Dysfxn Dyspnea/Hypoxia Infarct Ulcers, Infarcts Adrenal infarcts Petechiae Echymosis Oozing Intracranial bleeding Hematuria Hemorrhagic lung Massive hemorrhage.
- 15. Symptoms and Signs COMPLICATION Bleeding Thrombosis Hypotensionor shock Organ dysfunction
- 16. Continuo • Bleeding : Itmay 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.
- 18. Treatment Modalities TREATMENT • Treatthe 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 theCare 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 andinterventions 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.
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