DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

INTRODUCTION: Disseminated intravascular coagulation (DIC) is a potentially life-threatening sign and not a disease itself, of a serious underlying disease mechanism. In this condition there is a problem that predominates and over activate the immune system which in turn over responds.

TRIGGERS OF DIC: Disseminated Intravascular Coagulation may be triggered by sepsis, trauma, cancer, shock, abruptio placentae, toxins, or allergic reactions. The severity of DIC is variable, but it is potentially life threatening.

PATHOPHYSIOLOGY OF DIC: In DIC, the normal hemostatic mechanisms are altered so that tiny clots form within the microcirculation of the body. These clots consume platelets and clotting factors, eventually causing coagulation to fail and bleeding to result. This bleeding disorder is characterized by low platelet and fibrinogen levels; prolonged prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time; and elevated fibrin degradation products (D-dimers).

CLINICAL MANIFESTATIONS: Clinical manifestations of DIC are primarily reflected in compromised organ function or failure, clot formation followed by ischemia to all or part of the organ and or, less often, bleeding.

1. Patient may bleed from mucous membranes, venipuncture sites, and gastrointestinal and urinary tracts.

2. Bleeding can range from minimal occult internal bleeding to profuse hemorrhage from all orifices.

3. Patients typically develop multiple organ dysfunction syndrome (MODS), and they may exhibit renal failure as well as pulmonary and multifocal central nervous system infarctions as a result of microthromboses, macrothromboses, or hemorrhages.

4. Initially, the only manifestation is a progressive decrease in the platelet count; then, progressively, the patient exhibits signs and symptoms of thrombosis in the organs involved.

ASSESSMENT AND DIAGNOSTIC FINDINGS: Clinically, the diagnosis of DIC is often established by a drop in platelet count, an increase in PT and activated partial thromboplastin time (aPTT), an elevation in fibrin degradation products, and measurement of one or more clotting factors and inhibitors.

MEDICAL MANAGEMENT: The most important management issue is treating the underlying cause of DIC. A second goal is to correct the secondary effects of tissue ischemia by improving oxygenation, replacing fluids, correcting electrolyte imbalances, and administering vasopressor medications. If serious hemorrhage occurs, the depleted coagulation factors and platelets may be replaced. A heparin infusion, which is a controversial management method, may be used to interrupt the thrombosis process. Other therapies include recombinant activated protein C and AT infusions.

RELATED;

1.  BLOOD CLOTTING AND IT'S PREVENTION

2.  BLOOD AND IT'S COMPONENTS

3.  THE ABO BLOOD GROUPING

4.  BLOOD PLASMA

5.  THROMBOCYTOPENIA

6.  NOSE BLEEDING

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