DISSEMINATED INTRAVASCULAR COAGULATION (consumptive coagulopathy)

·         A grave blood coagulation disorder occurs as a complication of conditions that accelerate clotting wherein activation of thrombin & fibrinolytic system results in simultaneous bleeding & thrombosis.

·         Caused by infections, obstetric complications, neoplastic disease, tissue necrosis, cardiac arrest, stroke, incompatible blood transfusion, etc.

Signs & Symptoms:

ü  Petechiae

ü  Ecchymosis

ü  Dyspnea

ü  Prolonged bleeding after venipuncture

ü  Joint pain

ü  Hemorrhage

ü  Purpura

ü  Oliguria

ü  Anxiety

ü  Restlessness

Screening & Diagnosis:

·         Hematology -  ↓platelets, RBC, fibrinogen, factor assay (II,V,VII), ↑fibrin split products, thrombin, PT, PTT, (+) protamine sulfate test 

·         ABG analysis – metabolic acidosis

·         D-dimer test – result (+) ; specific test for DIC

Treatment:

·         Medications

o    Anticoagulants: heparin, antithrombin III (ATnativ^®, Thrombate^® III)

·         Blood transfusion – platelets, PRBC, FFP, whole blood, volume expanders, cryoprecipitates.

·         Bed rest

·         Oxygen therapy

·         IV therapy : hydration, electrolyte replacement, heparin lock

·         Hemodialysis

Complications:

·         Acute renal failure

·         Shock

·         CVA

·         Convulsions

·         Hemorrhage

·         Coma

Nursing Interventions:

·         Administer prescribed medications & IV fluids.

·         Monitor cardiovascular, respiratory, & fluid balance.

·         Avoid intramuscular injections, enemas, rectal temperatures & straight razors.

·         Check all IV & venipuncture sites frequently for bleeding.

·         Enforce complete bed rest during bleeding episodes.

·         Monitor for transfusion reactions.

·         Monitor results of blood studies & report any signs of complications.

·         Maintain seizure precautions.