Explain D.I.C. (OB rotation)

[FNPhopeful]

Anyone understand what DIC is? I have read everything about it but I need it explained in laymans terms.....its dissemiated intravascular coagulation?

Im not getting whats happening.

Thanks yall

[decartes]

In layman's terms, it's a vicious cycle where blood clots are widely spread in the blood and the body releases anticoagulants as a response to the point where clotting factors are practically exhausted and clotting times are markedly increased...something like that.

[KellieNurse06]

ok...simply put ( I hope) it is when the body has a hyper response to bleeding/clotting....tons of tiny clots yet not enough clotting factors in the blood.....so the body will bleed from any/every orifice there is........eyes,nose,mouth, injection/iv sites etc...well you get the picture, right? They give heparin & blood products to try to reverse the DIC.....and hope it works...... thats pretty much the simple way of explaining it from what I can think off the top of my head.....if I am wrong someone please correct me...

[S.T.A.C.E.Y, LPN]

GOOD QUESTION!!! Now my own too:

If you are bleeding from every orifice, why would heparin help?

Is the risk of DIC stroke from all of these blood clots, or bleeding out? Is the problem that all b/c there are all of these little clots everywhere, there are no longer any clotting factors left to clot where needed???

[wtbcrna, MSN, DNP, CRNA]

GOOD QUESTION!!! Now my own too:

If you are bleeding from every orifice, why would heparin help?

Is the risk of DIC stroke from all of these blood clots, or bleeding out? Is the problem that all b/c there are all of these little clots everywhere, there are no longer any clotting factors left to clot where needed???

You're using up all your clotting factors trying to stop bleeding from microclots. The Heparin is used to break the cycle of bleeding....clot....bleeding....clot...by preventing the formation of new clots and thereby stopping the clot formation, and then, hopefully, the bleeding.

Here is an article from the internet that hopefully explains it better.

DIC is a disorder of the "clotting cascade." It results in depletion of clotting factors in the blood.

Causes, incidence, and risk factors

DIC is when your body's blood clotting mechanisms are activated throughout the body instead of being localized to an area of injury. Small blood clots form throughout the body, and eventually the blood clotting factors are used up and not available to form clots at sites of real tissue injury. Clot dissolving mechanisms are also increased.

This disorder has variable effects, and can result in either clotting symptoms or, more often, bleeding. Bleeding can be severe. DIC may be stimulated by many factors. These include infection in the blood by bacteria or fungus, severe tissue injury (as in burns and head injury), cancer, reactions to blood transfusions, and obstetrical complications (such as retained placenta after delivery).

Risk factors are recent sepsis, recent injury or trauma, recent surgery or anesthesia, complications of labor and delivery, leukemia or disseminated cancer, recent blood transfusion reaction, and severe liver disease.

Symptoms

Bleeding, possibly from multiple sites in the body

Thrombosis formation evidenced by bluish coloration of the fingers

Sudden bruising

Signs and tests

Fibrinogen or fibrin - high degradation products

Serum fibrinogen - low

Prothrombin time (PT) - high

Partial throboplastin time (PTT) - high

Platelet count

Thrombin time test

Treatment

The goal is to determine the underlying cause of DIC and provide treatment for that.

Replacement therapy of the coagulation factors is achieved by transfusion of fresh frozen plasma. Cryoprecipitates may also be used if fibrinogen is significantly low. Heparin, a medication used to prevent thrombosis, is sometimes used in combination with replacement therapy.

[tjnurse06]

here is the way it was explained to me:

all of your clotting factors rush to that area of your body, (it could be a clot, laceration or for instance after delivery of a baby) that leaves the rest of your body with nothing to help it clot so your start bleeding from every orifice.

[Daytonite, BSN, RN]

The culprit in DIC is thrombin. It has gone postal.

Thrombin has two jobs that it performs. (1) It stimulates fibrin production which uses up the body's stores of platelets and clotting factors in the creation of blood clots, and (2) it activates the process of fibrinolysis which breaks down the blood clots. The whole process of blood clot formation and fibrinolysis is part of the normal healing mechanism for boo-boos. A blood clot forms over a cut and as healing occurs the clot is gradually reduced in size through fibrinolysis, or liquefication of the blood clot.

In DIC you've got a system wide fubar (f****d up beyond all recognition). The body is over producing thrombin and dumping it into the circulation where, like a crazed coke addict, it is madly making blood clots out of thrombin and clotting factors--and, like a runaway train, it ain't stopping. And that's the problem. The process has gone haywire and is way out of control because it is occurring on such a huge, system wide scale. The process of fibrinolysis tries to keep up. However, in an unfortunate turn of fate, fibrinolysis, in trying to keep up with and undo the blood clot formation which is occurring throughout the circulatory system, produces large quantities of byproducts that have anticoagulant properties that are going to contribute to any hemorrhage that might occur. Various degrees of hemorrhage result depending on how much of these byproducts are being produced.

It's a vicious situation. Clots are forming and circulating throughout the cardiovascular system. Because all the clotting factors have been used up in the blood clot formation, blood or serous fluid starts to seep out of any breaks in skin integrity (IV sites, injection sites, boo boos). You may also see petechiae and/or bruising. If the cause of the unchecked thrombin production isn't determined and corrected, blood clots will eventually lodge in blood vessels throughout the body. Some of these clots will manage to obstruct tissue perfusion and lead to tissue ischemia, infarction and necrosis of various organ tissues. In acute DIC the patient will go on to develop ATN (acute tubular necrosis), shock, and multiple organ failure as a result of these events.

[Daytonite, BSN, RN]

GOOD QUESTION!!! Now my own too:

If you are bleeding from every orifice, why would heparin help?

Is the risk of DIC stroke from all of these blood clots, or bleeding out? Is the problem that all b/c there are all of these little clots everywhere, there are no longer any clotting factors left to clot where needed???

There's some controversy as to whether Heparin is a good therapeutic treatment for DIC. Many medical experts recommend that the cause of the DIC be treated and not the DIC itself. Yes, stroke is a risk of DIC. What is more likely to happen, however, is that small clots lodge in smaller blood vessels of various organs causing infarcts, pain and eventual tissue necrosis. This leads to organ failure. The problem with DIC is that all the clotting factors are tied up in the process of clot formation that has been stimulated by the cause of the DIC. This process of clot formation is in over-drive. The body is basically left with no clotting mechanisms, so the body is unable to develop a clot at any opening in the skin or injury that might occur where it is really needed.

We had cancer patients who got DIC. They used to constantly bleed or ooze serum from their IV and injection sites. It was a real problem keeping them covered to catch the drainage. They had to be careful not to bump or cut themselves. And, of course, everyone was on pins and needles and watching for any signs and symptoms of a stroke or other infarct.

[S.T.A.C.E.Y, LPN]

To FNPhopeful, thanks for asking the question.

And, to everyone else thanks for the lesson in DIC!

[youknowho]

Our instructor called it "death is coming" DIC

[KellieNurse06]

Our instructor called it "death is coming" DIC

lol...not funny at all but her mnemonic is now something I will always remember.....that's a good one!