Disseminated Intravascular Coagulation (DIC)

Description

This condition is a bleeding disorder resulting from the widespread overstimulation of the body's clotting and anticlotting mechanisms in response to illness, stress, or both. Disseminated intravascular coagulation (DIC) occurs mainly within the capillaries or the micro-circulation. It is a secondary complication of a diverse group of disorders that activate, in some way, the coagulation system.

Causes

Disseminated intravascular coagulation occurs when the body's clotting mechanisms are activated throughout the body in response to an injury or a disorder, instead of being isolated to the area of initial onset. Platelets circulating throughout the body form small blood clots (thrombi) primarily in the area of the capillaries. This eventually causes the clotting factors to be used up, and none are left to form clots at the site of the injury. The presence of numerous small clots precipitates the release of clot-dissolving mechanisms, and the end result is generalized bleeding throughout the body. It is, in essence, a paradoxical situation—numerous microthrombi are being formed in the capillaries and the body reacts to dissolve these clots. It is sometimes called consumptive coagulopathy to indicate this paradox because the intravascular clotting rapidly consumes the products necessary for clotting: fibrinogen, platelets, prothrombin, and clotting factors V, VIII, and X.

Disseminated intravascular coagulation should be suspected in any individual who has an unexplained tendency toward bleeding and has experienced any clinical condition that introduces coagulation-promoting factors into the circulation. These conditions include placental abruption; retained dead fetus; amniotic fluid embolism; metastatic cancer of the pancreas, lung, stomach, or prostate; and acute leukemia. Any condition that also causes decreased blood flow, such as hypotension, can stimulate DIC. Widespread injury to the tissues throughout the body, as in severe burns, trauma, heat stroke, surgery, various types of infections by bacteria and fungus, snake bites, and fat embolism, can precipitate the cascade of factors to produce DIC. Excessive bleeding can appear suddenly and progress rapidly to severe or fatal hemorrhage. Signs and symptoms that appear gradually are prolonged bleeding from a venipuncture site, bleeding gums, nosebleeds, and bruising easily as well as the presence of minute, pinpoint red spots caused by bleeding under the layer of the skin.

Treatments

The objective of treatment is to determine the underlying cause of DIC and treat it, because this underlying cause predicts the probable outcome. The presence of inadequate blood components can be overcome with fresh frozen plasma and blood transfusions. Fibrinogen replacement can also occur by transfusion of blood products. When the primary disease cannot be treated, intravenous injections of heparin, a medication used to prevent thrombosis, are sometimes used in combination with replacement therapy. The use of heparin is, however, very controversial because it can cause bleeding itself.

Alternative and complementary therapies

Disseminated intravascular coagulation is an extremely serious condition precipitated by extraordinary events. Because it is an immediate, life-threatening situation, alternative and complementary therapies are not recommended during this phase. As an individual improves, it is important to utilize relaxation, visualization and imagery as well as vitamin and mineral supplements to promote healing.

Linda K. Bennington, C.N.S., M.S.N.

Cryoprecipitate

—A preparation of antihemophilic factor used in the management of hemophilia.

Embolism

—The sudden blocking of an artery by a clot of foreign material (fat, air bubble, tissue, clump of bacteria, blood clot). This foreign material is referred to as the embolus.

Polycythemia

—An increase in the total red cell mass of the blood.

Thrombus

—Blood clot: an accumulation of blood factors, primarily platelets and fibrin with entrapment of cellular elements, which frequently cause an obstruction in the circulation of blood. Microthrombi are very small blood clots.

Venipuncture

—Surgical puncture of a vein.