Otterbein University

Digital Commons @ Otterbein

Master of Science in Nursing (MSN) Student
Student Research & Creative Work
Scholarship

7-2018

Disseminated Intravascular Coagulation (DIC)

Nicholas A. Brown
Otterbein University, brown1@otterbein.edu

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Recommended Citation
Brown, Nicholas A., "Disseminated Intravascular Coagulation (DIC)" (2018). Master of Science in Nursing (MSN) Student Scholarship.
317.
https://digitalcommons.otterbein.edu/stu_msn/317

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Topic Statement
Investigation of disseminated
intravascular coagulation (DIC) in
the critical care setting, and how
it contributes to multi-system
organ failure.
Introduction
Etiology &
Presentation
Clinical conditions identified
as etiologies that can lead to
the development of DIC
(McCance et al., 2014, p.
Disseminated Intravascular Coagulation (DIC)
Nicholas Brown, BSN, RN
Otterbein University, Westerville, Ohio
References
Signs & Symptoms Significance Implications for Boral, DO, B., Williams, MD, D., & Boral,
MD, MBA, L. (2016). Disseminated
Depends on underlying Though DIC presents in Nursing Care
disease process, and
Intravascular Coagulation. American Journal of
under 20% of ICU Quick and accurate clinical
Clinical Pathology, 146 (6), 670-680.
doi:10.1093/ajcp/aqw195
whether presentation is admissions, Toh et al. (2016) diagnosis is critical, therefore
acute or chronic shares that “the presence of nurses need to be aware of
Gando, S., Meziani, F., & Levi, M. (2016). What’s
New in the Diagnostic Criteria of
• Result of either DIC increases the chances of what indicators to look for Disseminated Intravascular Coagulation? Intensive
hemorrhage or mortality beyond those of that indicate organ failure.
Care Medicine, 42 (6), 1062-1064.

DIC has been widely 1044): doi:10.1007/s00134-016-4257-z

recognized as a contributing
factor in the outcome of
several illnesses (Gando, et
al., 2016), and is typically a
manifestation of an
underlying pathologic or
disease process (Boral et al.
(2016). Boral et al. (2016)
further relays that “DIC is
relatively uncommon in the
general hospitalized patient
but accounts for 9% to 19% of
ICU admissions and has a high
mortality rate of 45% to 78%.”
To better understand this
complex process, it is
important to discuss normal
pathogenesis, and what leads
to the DIC cascade in critically
ill patients.
Normal hemostasis:
• A localized process
• Outcome is a platelet
plug made through
platelet adhesion and
aggregation
• Secondary fibrin clot
through activation of the
coagulation cascade
• Leads to the formation of
thrombin
(Boral et al., 2016)
DIC:
• Acquired syndrome
characterized by
intravascular activation
of coagulation
• No specific localization,
results from different
causes
• Can cause damage to the
microvasculature, and
can lead to organ
dysfunction
(Boral et al., 2016)
thrombosis Nurses should assess for:
• Sepsis/infection (gram- the primary disease.” This is Lee, MD, D. H., Lee, MD, Ph.D., B. K., Jeung, MD,
• Most common • Changes in LOC, confusion Ph.D., K. W., Jung, MD, Y. H., Lee, MD,
positive or gram- why early recognition Is
symptom is bleeding- • Seizure activity S. M., Cho, MD, Y. S., Yun, Ph.D., S.-W., & Min, MD,
negative bacteria, essential, and leads to better Ph.D., Y. I. (2017). Disseminated Intravascular
from lines and wounds, • Oliguria Coagulation is Associated with the Neurologic
malaria, fungi, viral outcomes for the affected Outcome of Cardiac Arrest Survivors. The American
purpura, petechia, • Hematuria
hemorrhagic fever) patient. Recognition of DIC is Journal of Emergency Medicine, 35 (11), 1617-1623.
hematomas, bleeding • Hypoxia doi:10.1016/j.ajem.2017.04.077
• Malignancies (metastatic not an easy task for health
from eyes, nose, gums • Hypotension Levi, M. (2014). Diagnosis and Treatment of
cancer or acute care providers as the process
• Can lead to shock; most • Hemoptysis Disseminated Intravascular Coagulation.
leukemia)
demonstrate bleeding Underlying Pathophysiology has a “dynamic progression” • Chest pain
International Journal of Laboratory Hematology, 36
(3), 228-236. doi:10.1111/ijlh.12221
• Pregnancy complications The pathophysiology of DIC is complex, and “A variety of
from 3 or more and manifests in a variety of • Tachycardia
(amniotic fluid Levi, M. (2018). Pathogenesis and Diagnosis of
unrelated sites mechanisms contributing to the derangement of coagulation in ways (Toh et al., 2016). As (McCance et al., 2014, p. 1046) Disseminated Intravascular Coagulation.
embolism, abruptio International Journal of Laboratory Hematology, 40
(McCance et al., 2014, p. DIC have been elucidated.” (Levi, 2018). The significance of this the end result of Diagnosis is confusing and (1), 15-20. doi:10.1111/ijlh.12830
placentae, intrauterine process is inherent in the fact that a variety of factors, such as difficult, meaning the bedside
1046) uncontrolled DIC leads to
fetal demise) endothelial injury and inflammation, can initiate DIC (McCance et nurse plays a critical role in
McCance, K.L., Huether, S.E., Brashers, V.L., & Rote,
• Symptoms of organ failure, prompt N.S. (eds.). (2014). Pathophysiology: The Biologic
• Severe trauma (head al., 2014, p. 1045). early identification of Basis for Disease in Adults and Children (7th ed.). St.
thrombosis are not recognition and treatment
injury, burns, etc.) • Suppression of normal homeostasis symptoms.
Louis, MO: Elsevier/Mosby.
quite as evident- gives patients a better
• Liver disease • Tissue factor (TF) release by endothelium or monocytes The nurse must also be Toh, MD, C.-H., Alhamdi, Ph.D., Y., & Abrams, Ph.D.,
determines the degree chance at recovery. The
• Immunologic reactions • TF initiates the coagulation cascade, leading to thrombin cognizant of the pertinent lab
S. (2016). Current Pathological and Laboratory
of morbidity and risk of Considerations in the Diagnosis of Disseminated
(severe anaphylaxis, activation, production of fibrin, and polymerization in a fibrin
significance of this is that values that drive treatment of Intravascular Coagulation. Annals of Laboratory
death (McCance et al., Medicine, 36 (6), 505-512.
hemolytic transfusion clot (McCance et al., 2014, p. 1045) organ failure most frequently DIC: doi:10.3343/alm.2016.36.6.505
2014, p. 1046)
reactions) • Clot digestion through plasmin activity → fibrin degradation involves the lungs and • Blood component therapy Additional Sources
• Asymptomatic to life-
• Vascular abnormalities products kidneys, followed by the based on lab findings Clark, Steven L. (2015). Chapter 31: Disseminated
threatening symptoms- Intravascular Coagulopathy. Retrieved from
(giant hemangiomas, • Tumor necrosis factor-α inhibits plasmin generation → brain, heart, liver, spleen, • FFP for INR > 1.5
difficult for nurses to https://obgyn.mhmedical.com/content.aspx?bookid
large aortic aneurysms) diminished fibrinolysis adrenals, pancreas, and GI • Platelet concentrates for =1580&sectionid=96351365
identify in an acute
• Hypoxia • Further induction of cytokine release by monocytes tract (Boral et al., 2016). platelets < 50,000 Medbullets (2018). Disseminated Intravascular
presentation
(Levi, 2018) • Coagulation cascade, including thrombin, activates Once the cascade has been • Cryoprecipitate for Coagulation. Retrieved from
https://step1.medbullets.com/hematology/114067/
fibrinogen < 100 mg/dl disseminated-intravascular-coagulation-dic
inflammatory systems, as well as the kinin and complement initiated, providers struggle
• RBC for hematocrit < 21%
systems to control and reverse the Schub, E., & Balderrama, D. (2018). Disseminated
(Boral et al., 2016) Intravascular Coagulation (DIC). CINAHL Nursing
• Mediators produced affect vascular endothelium → damage it causes to critically Guide.
increased permeability ill patients.
• Contributes to hypotension and potential shock
• Uncontrolled consumption of platelets and clotting factors
→ potential systemic hemorrhages Conclusion
DIC is dynamic and complex, requiring vigilant monitoring from
• Excess activation of coagulation and platelets → systemic
microvascular thrombosis → blockage of vessels with the bedside nurse. Prompt recognition of the underlying
progressive ischemia disease process is critical for successful patient outcomes, as
• Uncontrolled DIC will ultimately lead to multi end-organ there is no one lab test that is used to diagnose DIC (McCance
failure (McCance et al., 2014, p. 1045) et al., 2014, p. 1047). Presentation can range from acute life-
https://step1.medbullets.com/hematology/114067/dissemin
(Levi, 2018) threatening to stable chronic, so the clinical course will vary
ated-intravascular-coagulation-dic
from patient to patient.