F - Hematological disorders: Disseminated intravascular coagulation (DIC) Wk8

Question 1

Whats Disseminated intravascular coagulation DIC?

Answer 1

1. rare but life-threatening condition
2. accelerated clotting within blood vessels -> increased consumption of platelets & clotting factors -> uncontrollable bleeding

Question 2

Whats the physiology of clotting/coagulation cascade?

Answer 2

1. activated in response to an injury to limit the bleeding
   - normally, when a tissue and its blood vessels are injured -> circulating platelets are activated locally -> aggregate to form temporary plug at the site of injury
2. platelet plug attracts circulating clotting factors -> starts off the coagulation cascade
   - each clotting factor starts activating the next clotting factor -> activation of factor X/ prothrombin -> into factor Xa / thrombin
3. thrombin converts factor I / fibrinogen -> factor Ia or fibrin -> builds a tightly connected mesh that stabilizes the platelet plug
4. to avoid excessive clotting -> same thrombin initiates a negative feedback loop that converts the protein plasminogen -> active form plasmin
   - Plasmin breaks down the fibrin mesh -> dissolving the clot through fibrinolysis

Question 3

What are the causes of DIC?

Answer 3

presence of an underlying disorder that triggers uncontrolled activation of the coagulation cascade

1. most common cause: sepsis.
2. cancer, serious trauma, and obstetric complications, such as a placental abruption or amniotic fluid embolism
3. severe immune reaction
   - can be triggered by an incompatible blood transfusion, organ transplant rejection, or toxins like snake or spider venom

Question 4

Whats the pathology of DIC?

Answer 4

1. severe disorder or immune reaction triggers massive systemic activation of the coagulation cascade -> widespread clot formation intravascularly = disseminated intravascular coagulation
2. clots can block small & midsize vessels -> ischemia / necrosis of the involved tissue
3. widespread clotting -> increased consumption of platelets and clotting factors
4. pts at risk of uncontrollable and life-threatening bleeding
   - even from minor injuries like venipuncture sites

Question 5

What are the clinical manifestations of DIC?

Answer 5

1. undue bleeding from the nose, gums, or mouth
2. blood in the stools due to gastrointestinal bleeding
3. blood in the urine due to urinary tract bleeding
   - visual changes due to retinal hemorrhage or simply blood oozing from puncture sites

More severe manifestations of deep tissue bleeding:
altered mental status, chest pain, and dyspnea, along with palpitations, tachycardia, and even shock.

clinical manifestations from clotting.
venous thromboembolism
DVT: obstructed venous flow in the legs may present with leg pain and swelling.
arterial thrombosis -> ischemia and even necrosis of the involved organ
bluish discoloration of nail beds and lips due to cyanosis

complications like myocardial infarction or stroke.

Ultimately, the combination of bleeding and ischemia may result in organ hypoperfusion, which may even lead to multi-organ failure.

Question 6

What are the treatment options for DIC?

Answer 6

1. supportive measures
   - IV fluids and blood products to replace the blood loss
2. anticoagulant medications
   - counteract excessive clotting
   - ventilator support in cases of respiratory failure
3. focus on addressing the underlying cause

Question 7

What is the nursing care you’ll provide for a client with DIC?

Answer 7

• decrease bleeding
• monitor for abnormal clotting
• address underlying cause

1. Assess vitals , skin & neurological status for signs of bleeding, and monitor CBC
   - Watch for signs of clot formation and microcirculatory clotting
2. Give o2 and prescribed IV fluids to prevent hypovolemia
   - fresh frozen plasma and platelets to promote clotting and slow bleeding
3. insert IDC to monitor urine output