dic presentation by samriti sharma

1. CHILDREN MUST BE TAUGHT HOW TO
THINK, NOT WHAT TO THINK.”

2. “
”
PRESENTED BY :
SAMRITI SHARMA
MSC NURSING 2ND YEAR (CHN)

3. BASICS TO UNDERSTAND THE DISEASE
CONDITION
• DISSEMINATED Means wide spread
• INTRAVASCULAR Means with in the vessels
• COAGULATION Means the process by which a
blood clot is formed.

4. INTRODUCTION
• Disseminated intravascular coagulation
(DIC) is a rare but serious condition that
causes abnormal blood clotting throughout
the body’s blood vessels.

5. CONT……….
• It is an Thrombohemorrhagic disorder.
• So there are two phases in this disorder i.e
1. Thrombotic phase
2. Hemorrhagic phase

6. CONT……
• Disseminated intravascular coagulation (DIC) is a
serious medical disorder in which multiple clots
are formed that can lead to permanent end-organ
damage.
• Systemic activation of the blood coagulation
occurs that results in the generation and the
deposition of excess fibrin. This causes the
blockage of blood vessels by the thrombi.

7. CONT………
• DIC is also known as Consumption coagulopathy
increase clot formation
increase consumption of C. factors and platelets
deficiency of C. factor and platelets
prevent clot formation
increase bleeding

8. ANOTHER REASON FOR ABNORMAL BLEEDING
• It is due to plasmin activation,,,,,, because it destroy
clotting factor and leads to bleeding

9. DEFINITION
• DISSEMINATED INTRAVASCULAR COAGULATION
(DIC) IS A SERIOUS DISORDER IN WHICH THE
PROTEINS THAT CONTROL BLOOD CLOTTING
BECOME OVERACTIVE.

10. TYPES OF DIC
• ACUTE DIC
• CHRONIC DIC

11. ACUTE DIC
• It happened rapidly, the coagulopathy is dominant and major
symptoms are bleeding and Shock, mainly seen in severe infection
• An explosive generation of thrombin diminish clotting factors and
platelets and activates the fibrinolytic system. Bleeding into the
subcutaneous tissues, skin, and mucous membranes occurs, along
with occlusion of blood vessels caused by fibrin in the
microcirculation.

12. CHRONIC DIC
It happened slowly and last several weeks, thrombosis and clotting
may predominate ,mainly seen in cancer.
 Process is the same, but it is less explosive. Usually there is time for
compensatory responses to take

13. CAUSES
• Injury
• Infectious disease 31%~43%
• cancer 24%~34%
• Obstetric complications 4%~12%
• severe tissue injury 1%~5%
• systemic disease

14. RISK FACTORS
• Cancer, especially certain types of leukemia
• Inflammation of the pancreas
• Infection in the blood, especially by bacteria or
fungus
• Liver disease

15. CONT……..
• Recent surgery
• Severe tissue injury (as in burns and head injury)
• Large hemangioma (a blood vessel that is not
formed properly)

16. PATHOPHYSIOLOGY
• Disseminated intravascular coagulation occurs
when the first stages of the coagulation process is
abnormally stimulated.
• Although no well-defined sequence of events
occurs, two distinct phase can be identified or
two mechanism are there.

17. FIRST
• When the clotting mechanism is triggered in the circulation,
• Thrombin is generated in greater amounts that can be neutralized
by the body
• As a result, there is rapid conversion of fibrinogen to fibrin, with
aggregation and destruction of platelets.
• If local and wide-spread fibrin deposition in blood vessels take
place, obstruction and eventual necrosis of tissues occur.

18. SECOND
• If Fibrinolytic mechanism is activated
• Causing extensive destruction of clotting factors,
• The child is prone to uncontrollable hemorrhage into
vital organs.
• An additional complication is damage and hemolysis of
RBCs

19. SYMPTOMS OF DIC
SYMPTOMS OF DIC MAY INCLUDE ANY OF THE FOLLOWING:
• BLEEDING, FROM MANY SITES IN THE BODY
• BLOOD CLOTS
• BRUISING
• DROP IN BLOOD PRESSURE
• SHORTNESS OF BREATH
• CONFUSION, MEMORY LOSS OR CHANGE OF BEHAVIOR
• FEVER

20. DIAGNOSTIC EVALUATION
• There are three components of the diagnostic
workup. The detailed history, physical
examination, and laboratory investigations are
done.
• Physical examination is the most important step.
The treatment is started on the basis of positive
physical signs, while the results of the laboratory
investigations are awaited.

21. CONT…….
• DIC is a life-threatening condition and immediate treatment
is started without any delay. The signs to look for during the
examination are:
• Signs of hemorrhage
• Signs of localized thrombosis
• Altered consciousness
• Focal neurological deficits
• Hypotension and tachycardia

22. CONT…….
• Signs of ARDS (acute respiratory distress)
• Haematuria
• Oliguria
• Purpura
• Cyanosis
• Skin necrosis

23. LABORATORY INVESTIGATIONS
Tests Abnormality
• Platelet count
• Fibrin degradation product (FDP)
• Factor assay
• Prothrombin time (PT)
• Activated PTT
• Thrombin time
• Fibrinogen
• D-dimer
• Anti-thrombin
• Decreased
• Increased
• Decreased
• Prolonged
• Prolonged
• Prolonged
• Decreased
• Increased
• Decreased

24. TREATMENT OF DISSEMINATED INTRAVASCULAR
COAGULATION
• IDENTIFY AND TREAT THE UNDERLYING CAUSE.
The primary focus should be the diagnosis and treatment of the
underlying disorder that has given rise to DIC.
• REPLACEMENT THERAPY.
Administer fresh frozen plasma: the dose is 10–15 ml/kg and
it will improve the clotting factor activity by 10–15 %
Platelet transfusion should be used to maintain a platelet count greater
than 30000/μl, and 50000/μl.

25. CONT……..
• HEPARIN THERAPY :- (ESP. PT. WITH CHRONIC DIC)
In some cases heparin therapy is contraindicated, but when DIC is producing
serious clinical consequences and the underlying cause is not rapidly reversible,
heparin may be Necessary (dose:500~750u/h is necessary).
Note ;;
HEPARIN THERAPY MUST BE USED IN COMBINATION WITH REPLACEMENT
THERAPY, IT CAN LEAD TO SEVERE BLEEDING

26. CONT………
1-Acute DIC:- (depend on the case) 2. Chronic DIC :- (depend on the case )
 Without bleeding or evidence of ischemia:-
-No treatment
 With bleeding:-
1-Blood components as needed
2-Fresh frozen plasma
3 Cryoprecipitate
4 Platelet transfusions
 With ischemia:-
-Anticoagulants after bleeding risk is corrected
with blood products
 Without thromboembolism:-
-No specific therapy needed, but prophylactic
drugs (eg, low-dose heparin, low-molecular-
weight heparin) may be used for patients at
high risk for formation of thrombosis.
 With thromboembolism:-
- Heparin or low-molecular-weight heparin, trial of
warfarin sodium (Coumadin). (If warfarin is
unsuccessful, long-term use of low- molecular-
weight heparin may be helpful.)

27. COMPLICATIONS
• PERMANENT DAMAGE TO ORGANS.
• SEVERE HAEMORRHAGE
• GANGRENE
• CARDIAC TAMPONADE
• STROKE
• SHOCK
• DEATH

28. PROGNOSIS OF DISSEMINATED
INTRAVASCULAR COAGULATION
• The prognosis of the disease is very variable depending
on the cause and extent of thrombosis.
• An overall ‘poor prognosis’ is associated with dic. 10–50
% of people die as a result of DIC. Sepsis-related deaths
are more common than trauma-related DIC.