Disseminated intravascular coagulation

Question 1

What is DIC?

Answer 1

Disorder of haemostasis that can lead to multi-organ failure. Can be triggered by infection, cancer, trauma and pregnancy.

Endothelial damage occurs which results in cells releasing thromboplastins which initiates the coagulation cascade.

Clotting factors are used up forming clots throughout organs and vessels, and the site of the original damage. As clotting factors are used bleeding can start, leading to massive haemorrhage if untreated.

Question 2

How is DIC diagnosed and treated?

Answer 2

Diagnosed by blood tests - coag screen. Tests determine the use of blood products for treatment.

Identify and treat underlying cause.

Strict fluid balance - Catheter!

Question 3

How might DIC present?

Answer 3

Haemorrhage
Discoloured skin patches
Haematuria
Shock
Thrombotic complications in brain, lungs or kidneys
Acute pulmonary hypertension if trigger is AFE

Question 4

What are some trigger factors associated with DIC in pregnancy?

Answer 4

Miscarriage (especially septic)
Hydatidiform mole
Placenta accreta and PPH
Retained dead fetus
Acute fatty liver of pregnancy
Placental abruption (most common)
Placenta praevia
Preeclampsia
HELLP
AFE
Mismatched blood transfusion
Breast/ovarian/uterine cancer

Question 5

What are the considerations for labour in a woman with DIC?

Answer 5

Epidural and spinal anaesthesia usually contraindicated (GA necessary for operative delivery)

LSCS may be required:
- keep mother nil by mouth in case of GA

NVB:

• active management of third stage
• suture all perineal trauma

Both - vigilant examination of the placenta and observe blood loss for clotting and measure EBL closely.

Question 6

What is the largest component of blood?

Answer 6

Plasma - 55%, then RBC 45%

Question 7

What percentage of plasma is water?

Answer 7

91%

Question 8

Plasma is a colloid solution. What does this mean?

Answer 8

Particles are suspended in the liquid, they won’t settle to the bottom.

Question 9

What is erythropoiesis?

Answer 9

The synthesis of new RBCs. It is stimulated when the kidney’s detect a decrease in oxygen in the circulation.

Question 10

What is the most common type of leukocyte?

Answer 10

Neutrophils - make up 60% of leucocytes and are phagocitic cells that destroy bacteria.

Question 11

What is a vascular spasm?

Answer 11

When a vessel is punctured, the smooth muscle contracts and stops blood supply to the area (preventing bleeding).

Question 12

What are the three events that prevent excessive blood loss?

Answer 12

Vascular spasm
Platelet plug formation
Coagulation or blood clotting

Question 13

What is platelet plug formation?

Answer 13

Where the thrombocytes adhere to the site of damge, release their contents and aggregate to form a plug.

Question 14

What is coagulation?

Answer 14

Where the blood turns to a gel.

Question 15

What percentage of the population has a negative blood group?

Answer 15

15%

Question 16

What is sickle cell disease?

Answer 16

A mutation of beta-globin genes which results in chronic anaemia due to increased rate of destruction of RBC.

Question 17

What are the symptoms of sickle cell disease?

Answer 17

Anaemia
Failure to thrive
repeated infections
painful swelling in hands/feet
infarction
Abdo and chest pain

Question 18

What is thalassaemia?

Answer 18

An inherited blood disorder - usually diagnosed in childhood. Can be major or minor, and can be from the A or B thalassaemia genes.

Alpha - have changes in two copies of the gene
Beta - changes in only one copy - asymptomatic

Minor - they have mild to no symptoms, but can pass onto their children.

Major - RBC’s destroyed more quickly resulting in severe anaemia, pallor, sleep difficulties, poor appetite, failure to thrive, lethargy.

Question 19

How is symptomatic thalassaemia treated?

Answer 19

Regular blood transfusions.

Question 20

Thalassaemia screening should be done for couples considering conceiving. T or F.

Answer 20

True - with genetic counselling if they are both carriers.

Question 21

What is the normal range for platelets?

Answer 21

150 - 450

Question 22

What are the s/s of thrombocytopenia?

Answer 22

Petichiea (small red spots on the skin)
Bleeding gums
Nosebleeds
Malaise

Question 23

What can cause thrombocytopenia?

Answer 23

1. Decreased production due to infections or leukemia
2. Increased destruction from autoimmune disease, blood borne infection.
3. Medication induced - alcohol abuse, interferon, chemotherapy, sulphur antibiotics, Quinine