Disseminated intravascular coagulopathy Flashcards
What is Disseminated Intravascular Coagulopathy (DIC)?
DIC is a bleeding and clotting disorder secondary to an underlying systemic process, resulting in thrombin or plasmin dominance.
What are the clinical signs and symptoms of DIC?
Clinical signs include active vaginal bleeding (blood appears thin without clots), gastrointestinal bleeding, epistaxis, oozing from puncture and surgical wounds, purpura, oliguria, pulmonary edema, and reduced consciousness.
What are the key investigations for diagnosing DIC?
Key investigations include Full Blood Count (FBC) for hemoglobin (Hb) and platelets, clotting time (blood should clot within 8 minutes in a red top tube), PT/PTT/fibrinogen (if available), and abdominal ultrasound to evaluate for intra-abdominal/pelvic bleeding
What are the initial management steps for a patient with DIC?
Initial management includes admitting the patient to the HDU or ICU, ensuring CAB (Circulation, Airway, Breathing), providing oxygen, placing 2 large bore (16 or 18 gauge) IV lines, catheterizing the patient to monitor urine output every hour, and contacting the blood bank immediately for blood products.
What blood products should be administered to a patient with DIC?
Administer 2-6 units of whole blood if different components are not available. If components are available, give 2-6 units of PRBCs first, 2-6 units of FFP at a 1:1 ratio with PRBCs, platelets at 1-2 units/10 kg of body weight, and cryoprecipitate at 10-20 ml/kg if FFP is not available.
What volume resuscitation should be initiated while awaiting blood products for DIC?
Begin volume resuscitation immediately with 2L of Normal Saline (NS) or Ringer’s Lactate (RL) until blood products arrive.
What additional conditions should be evaluated and treated in a patient with DIC?
Evaluate and treat the cause of bleeding, considering uterine atony, cervical or vaginal tears, retained tissue, and thrombin disorders. Manage based on the “4 Ts” (Tone, Trauma, Tissue, Thrombin) if postpartum, and consider heparin if thrombosis is dominant.
