Understanding Disseminated Intravascular Coagulation (DIC) “An ...

Understanding Disseminated Understanding Disseminated Intravascular Coagulation (DIC) Intravascular Coagulation (DIC)

“An Oncologic Emergency”“An Oncologic Emergency”

Deborah Kwasneske RN, BSN, OCNDeborah Kwasneske RN, BSN, OCNMSN 621, Spring 2006MSN 621, Spring 2006

Alverno CollegeAlverno CollegeEmail: [email protected]: [email protected]

WelcomeWelcome

This tutorial is self guided by using buttons to move about screens. This tutorial is self guided by using buttons to move about screens. You can return to the main screen at anytime by using the home You can return to the main screen at anytime by using the home button. The arrow buttons allow you to move forward or back. button. The arrow buttons allow you to move forward or back.

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There are multiple hyperlinks to outside learning sources to help with There are multiple hyperlinks to outside learning sources to help with the understanding of DIC . To get back to DIC tutorial use back the understanding of DIC . To get back to DIC tutorial use back button on links.button on links.

For the case study answers, just click on the question for answers to For the case study answers, just click on the question for answers to appear. You can return to the case study using the return key.appear. You can return to the case study using the return key.

Understanding Disseminated Intravascular Understanding Disseminated Intravascular Coagulation (DIC) “An Oncologic Emergency”Coagulation (DIC) “An Oncologic Emergency”

Introduction

Pathophysiology

Treatments GlossaryCase Study

References

Genetics

DICWhat isDIC

Inflammation

ObjectivesObjectives

Understand the pathophysiology of Understand the pathophysiology of Disseminated Intravascular Coagulation (DIC)Disseminated Intravascular Coagulation (DIC)Identify risk factors and etiology of DICIdentify risk factors and etiology of DICDescribe the signs and symptoms of DICDescribe the signs and symptoms of DICIdentify treatment modalities for DICIdentify treatment modalities for DICDefine, identify and understand Acute vs Define, identify and understand Acute vs Chronic DICChronic DICDevelop understanding of diagnosing DIC (lab Develop understanding of diagnosing DIC (lab interpretations) interpretations)

What is DIC?What is DIC?Is considered an “acquired bleeding disorder”Is considered an “acquired bleeding disorder”Is not a disease entity but an event that can Is not a disease entity but an event that can accompany various disease processesaccompany various disease processesIs an alteration in the blood clotting Is an alteration in the blood clotting mechanism:abnormal acceleration of the mechanism:abnormal acceleration of the coagulation cascadecoagulation cascade, resulting in thrombosis, resulting in thrombosisAs a result of the depletion of clotting factors, As a result of the depletion of clotting factors, hemorrhage occurs simultaneouslyhemorrhage occurs simultaneouslyIs a Is a Paradoxical Clinical PresentationParadoxical Clinical Presentation “clotting “clotting and hemorrhage”and hemorrhage”

((Porth, C.M. (2004) Essentials of Pathophysiology) & (Otto, S. (2001). Oncology Porth, C.M. (2004) Essentials of Pathophysiology) & (Otto, S. (2001). Oncology Nursing)Nursing)

PathophysiologyPathophysiology

In DIC, a systemic activation of the In DIC, a systemic activation of the coagulation system simultaneously leads coagulation system simultaneously leads to thrombus formation (compromising to thrombus formation (compromising blood supply to various organs) and blood supply to various organs) and exhaustion of platelets and coagulation exhaustion of platelets and coagulation factors (results in hemorrhage). This is a factors (results in hemorrhage). This is a disruption of body homeostasis. disruption of body homeostasis.

(Porth, 2001)(Porth, 2001)

PathophysiologyPathophysiologyThrombosisThrombosis-brief period of -brief period of

hypercoagulabilityhypercoagulability1)1) Coagulation cascade is Coagulation cascade is

initiated, causing initiated, causing widespread fibrin widespread fibrin formationformation

2)2) Microthrombi are Microthrombi are deposited throughout he deposited throughout he microcirculatory microcirculatory

3)3) Fibrin deposits result in Fibrin deposits result in tissue ischemia, hypoxia, tissue ischemia, hypoxia, necrosisnecrosis

4)4) Leads to multi organ Leads to multi organ dysfunction dysfunction

(Porth, 2004) & (Otto, 2001)(Porth, 2004) & (Otto, 2001)

FibrinolysisFibrinolysis-period of -period of hypocoagulability (the hypocoagulability (the hemorrhagic phase)hemorrhagic phase)

1)1) Activates the Activates the complementcomplement system system

2)2) Byproducts of fibrinolysis Byproducts of fibrinolysis (fibrin/fibrin degradation (fibrin/fibrin degradation products(FDP)) further products(FDP)) further enhance bleeding by enhance bleeding by interfering with platelet interfering with platelet aggregation, fibrin aggregation, fibrin polymerization, & polymerization, & thrombin activitythrombin activity

3)3) Leads to HemorrhageLeads to Hemorrhage

PathophysiologyPathophysiology

(Porth, 2004)(Porth, 2004)

Risk Factors and EtiologyRisk Factors and Etiology

Almost always a secondary event from Almost always a secondary event from activation of one of the coagulation activation of one of the coagulation pathwayspathwaysUnderlying pathology creates a triggering Underlying pathology creates a triggering event: Either-event: Either-– endothelial tissue injury (Extrinsic)endothelial tissue injury (Extrinsic)– blood vessel injury (Intrinsic)blood vessel injury (Intrinsic)

(Porth, 2004)(Porth, 2004)

Pathologic PathwaysPathologic PathwaysExtrinsicExtrinsic (endothelial) (endothelial)– Shock or traumaShock or trauma– Infections ( gram positive Infections ( gram positive

and gram negative sepsis, and gram negative sepsis, aspergillosis)aspergillosis)

– Obstetric complications Obstetric complications (eclampsia, placenta (eclampsia, placenta abruptio, fetal death abruptio, fetal death syndrome)syndrome)

– Malignancies: APML, AML, Malignancies: APML, AML, cancers of the lung, colon, cancers of the lung, colon, breast, prostate)breast, prostate)


Intrinsic Intrinsic (blood vessel)(blood vessel)– Infectious vasculitis (certain Infectious vasculitis (certain

viral infections, rocky viral infections, rocky mountain spotted fever)mountain spotted fever)

– Vascular disordersVascular disorders– Intravascular hemolysis Intravascular hemolysis

(hemolytic transfusion (hemolytic transfusion reactions)reactions)

– Miscellaneous: snakebite, Miscellaneous: snakebite, pancreatitis, liver diseasepancreatitis, liver disease

Oncology Related DICOncology Related DIC

Usually related to:Usually related to:– Disease processDisease process

-APML( acute promyelocytic leukemia)-APML( acute promyelocytic leukemia) -mucin-secreting adenocarcinomas-mucin-secreting adenocarcinomas

– Treatment of cancerTreatment of cancer-chemotherapy-chemotherapy-radiation-radiation

– Concomitantly with sepsisConcomitantly with sepsis -10-20% with gram-negative -10-20% with gram-negative

(Otto, S. (2001). Oncology Nursing)(Otto, S. (2001). Oncology Nursing)

Clinical FeaturesClinical Features

Onset maybe Acute or ChronicOnset maybe Acute or Chronic– Acute DICAcute DIC

Develops rapidly over a period of hoursDevelops rapidly over a period of hoursPresents with sudden bleeding from multiple sitesPresents with sudden bleeding from multiple sitesTreated as a medical emergencyTreated as a medical emergency

– Chronic DICChronic DICDevelops over a period of monthsDevelops over a period of monthsMaybe subclinicalMaybe subclinicalEventually evolves into an acute DIC patternEventually evolves into an acute DIC pattern

(Otto, 2001)(Otto, 2001)

Signs and Symptoms Signs and Symptoms

Most common sign of DIC is bleedingMost common sign of DIC is bleeding -manifested by ecchymosis, petechiae,and -manifested by ecchymosis, petechiae,and

purpurapurpura-bleeding from multiple sites either oozing or -bleeding from multiple sites either oozing or frank bleedingfrank bleeding-cool and or mottled extremities may be noted -cool and or mottled extremities may be noted -dyspnea and chest pain if pleura and -dyspnea and chest pain if pleura and pericardium involvementpericardium involvement-hematuria-hematuria


Genetic ComponentGenetic ComponentNone associated with DICNone associated with DIC BUT-------BUT-------Genetic mutations to the clotting cascade Genetic mutations to the clotting cascade

can lead to coagulation disorders:can lead to coagulation disorders:Hemophilla A and BHemophilla A and Bvon Willebrand Factorvon Willebrand Factor

Impaired Synthesis of Coagulation Impaired Synthesis of Coagulation FactorsFactors

tutorial on homeostasistutorial on homeostasis http://alverno.edu.bownephttp://alverno.edu.bownep

http://faculty.alverno.edu/bowneps/hemostasis/h1.htm

Inflammation and DICInflammation and DIC

Sepsis is usually underlying process for Sepsis is usually underlying process for developmentdevelopmentEndotoxins associated with sepsis activate Endotoxins associated with sepsis activate factors and initiate coagulation.factors and initiate coagulation.Bacteria, virus also trigger the clotting cascade.Bacteria, virus also trigger the clotting cascade.Sepsis activates Sepsis activates complement cascadecomplement cascade..

http://http://tutorial on inflammationtutorial on inflammationP.Bowne, Alverno CollegeP.Bowne, Alverno College

http://faculty.alverno.edu/bowneps

Diagnosis/Lab FindingsDiagnosis/Lab FindingsTestTest

Platelet count Platelet count Fibrin degradation product Fibrin degradation product

(FDP)(FDP)Factor assayFactor assayProthrombin time (PT)Prothrombin time (PT)Activated PTTActivated PTTThrobimn timeThrobimn timeFibrinogenFibrinogenD-dimerD-dimerAntithrombinAntithrombin

AbnormalityAbnormalityDecreased Decreased IncreasedIncreased

DecreasedDecreasedProlongedProlongedProlongedProlongedProlongedProlongedDecreasedDecreasedIncreasedIncreasedDecreasedDecreased

(Otto,2001)(Otto,2001)

Treatment ModalitiesTreatment ModalitiesTreat the underlying causeTreat the underlying causeProvide supportive management of complicationsProvide supportive management of complicationsSupport organ functionSupport organ functionStop abnormal coagulation and control bleeding Stop abnormal coagulation and control bleeding by replacement of depleted blood and clotting by replacement of depleted blood and clotting components components (FFP,Platelets,PRBC)(FFP,Platelets,PRBC)Medications can be used and choice depends on Medications can be used and choice depends on the patient’s condition (Heparin, Antithrombin III the patient’s condition (Heparin, Antithrombin III (ATIII), Fibrinolytic inhibitors)(ATIII), Fibrinolytic inhibitors)

(Porth, C.M. (2004) Essentials of Pathophysiology) & (Otto, S. (2001). Oncology Nursing)(Porth, C.M. (2004) Essentials of Pathophysiology) & (Otto, S. (2001). Oncology Nursing)

Case Study/Post TestCase Study/Post TestD.G.,a 48-year-old, is 30 days post matched unrelated allogenic D.G.,a 48-year-old, is 30 days post matched unrelated allogenic

stem cell transplant for Acute Myelegenous Leukemia. His Lab stem cell transplant for Acute Myelegenous Leukemia. His Lab work is as follows:work is as follows:

WBC 480 WBC 480 SodiumSodium 130 130ANC 120ANC 120 PotassiumPotassium 3.7 3.7PltsPlts 35 35 BUN BUN 16 16HctHct 27 27 Creatinine Creatinine 1.4 1.4Hgb 10Hgb 10((

a) Based on the above lab values, what risk factors does D.G. ha) Based on the above lab values, what risk factors does D.G. have?ave?

The next morning after labs are drawn, D.G. developed a fever of The next morning after labs are drawn, D.G. developed a fever of 101.2 and BP fell to 98/60 (normally 130/76).101.2 and BP fell to 98/60 (normally 130/76).

((b)What may be the cause of the fever and low BP?b)What may be the cause of the fever and low BP?(c)What interventions should you as primary RN take at this time?(c)What interventions should you as primary RN take at this time?

Case Study cont.Case Study cont.D.G. is started on Vanco and Primaxin and given 1 D.G. is started on Vanco and Primaxin and given 1

liter fluid bolus over 2 hours. Blood cultures were liter fluid bolus over 2 hours. Blood cultures were drawn prior to antibiotic RX. His fever decreased drawn prior to antibiotic RX. His fever decreased to 99.8 and BP increased to 108/70.to 99.8 and BP increased to 108/70.

Overnight D.G. again became febrile to 102.4 with Overnight D.G. again became febrile to 102.4 with drop in BP to 70’s/50’s. Labs were drawn and drop in BP to 70’s/50’s. Labs were drawn and fluids started at 500cc/hr. Labs values were fluids started at 500cc/hr. Labs values were significant:significant:

ANCANC 100 100 Plts Plts 20 20HctHct 9 9 BUN 35 BUN 35HgbHgb 24 24 Creat 2.8Creat 2.8(a)What do the above lab values say about D.G. st(a)What do the above lab values say about D.G. status? (b)What interventions should be taken?atus? (b)What interventions should be taken?

Case Study cont.Case Study cont.MD orders 2 units of PRBC to be infused over 4 hours. During MD orders 2 units of PRBC to be infused over 4 hours. During

infusion BP increased to 90/48 and he continues to be febrile infusion BP increased to 90/48 and he continues to be febrile at 101.0.at 101.0.

D.G. is becoming more confused, complaining of GI pain and D.G. is becoming more confused, complaining of GI pain and cramping, developing a moist cough with rapid respiratory cramping, developing a moist cough with rapid respiratory rate.rate.

((a)What maybe causing the new symptoms?a)What maybe causing the new symptoms?

(b)What interventions do you take at this time?(b)What interventions do you take at this time?

(c)What maybe the underlying process? What else is he at risk f(c)What maybe the underlying process? What else is he at risk for?or?

Case Study cont.Case Study cont.O2 sats on RA measure 84% and lung sounds are coarse O2 sats on RA measure 84% and lung sounds are coarse

throughout. STAT ABG’s and CXR are done. X-ray results throughout. STAT ABG’s and CXR are done. X-ray results show diffuse consolidation and the ABGs demonstrate show diffuse consolidation and the ABGs demonstrate respiratory acidosis with hypoxemia. D.G. is placed on respiratory acidosis with hypoxemia. D.G. is placed on oxygen, O2 sats improve to 91%. Urine and stool output at oxygen, O2 sats improve to 91%. Urine and stool output at this time test heme positive. You also note he has small this time test heme positive. You also note he has small lower extremity bruising and scattered petechia. A lower extremity bruising and scattered petechia. A bronchoscophy is ordered and performed. Results show bronchoscophy is ordered and performed. Results show diffuse alveolar hemorrhage.diffuse alveolar hemorrhage.

((a) Based on D.G. history and the current clinical picture, whata) Based on D.G. history and the current clinical picture, what are potential causes for symptoms (GI, Respiratory, GU)? are potential causes for symptoms (GI, Respiratory, GU)?

(b) What information would be useful at this time for diagnosis?(b) What information would be useful at this time for diagnosis?

Case Study Cont.Case Study Cont.MD orders CBC and coagulation screen. The results are as MD orders CBC and coagulation screen. The results are as

follows:follows:WBCWBC <100 <100 PT 34 sec PT 34 secANCANC 0 0 PTT 72 PTT 72PltsPlts 12 12 Fibrinogen <100 Fibrinogen <100Hct 23Hct 23 FSP >1000 FSP >1000HgbHgb 9 9 D-dimer >500 D-dimer >500

((c)What secondary process is possibly occurring based on c)What secondary process is possibly occurring based on above values?above values?

((d)What interventions are appropriate? What should be thed)What interventions are appropriate? What should be the focus of your assessments? focus of your assessments?

Case Study Cont.Case Study Cont.D.G. Continues to be hypotensive. Lung sounds D.G. Continues to be hypotensive. Lung sounds

remain course, hemoptysis develops and CXR remain course, hemoptysis develops and CXR continues with diffuse consolidation. Urine and continues with diffuse consolidation. Urine and stool remain heme positive. After transfusion, stool remain heme positive. After transfusion, labs redrawn. Values as follows:labs redrawn. Values as follows:

PltsPlts 22 22 Pt 28Pt 28Hct 26Hct 26 PTT 54PTT 54Hgb 10Hgb 10 Fibrin <100Fibrin <100

FSP >1000FSP >1000((

a)What is the results of treatment based on abovea)What is the results of treatment based on above values? values?

(b)What interventions should be done?(b)What interventions should be done?

Case Study cont.Case Study cont.

D.G. status continues to deteriorate and D.G. status continues to deteriorate and needed to be intubated 2 days after needed to be intubated 2 days after developing DIC. The sepsis remained developing DIC. The sepsis remained unresolved and he went into acute renal unresolved and he went into acute renal failure. Family decided not to dialyze due failure. Family decided not to dialyze due to the multi-organ involvement. D.G. to the multi-organ involvement. D.G. expired 2 days later from the gram neg expired 2 days later from the gram neg sepsis and secondary DIC.sepsis and secondary DIC.

Answers for Case StudyAnswers for Case Study(a)Risk for infection, renal insufficiency, (a)Risk for infection, renal insufficiency,

neutropenia, bleeding based on lab neutropenia, bleeding based on lab values. WBC low along with the ANC values. WBC low along with the ANC makes patient more susceptible to makes patient more susceptible to infection. The BUN and creatinine are infection. The BUN and creatinine are elevated leading to possible renal elevated leading to possible renal problemsproblems

Answers for Case StudyAnswers for Case Study

(b)(b) Possible septic shock as a result of an Possible septic shock as a result of an underlying infection. Neutropenic patients underlying infection. Neutropenic patients are at high risk for development of are at high risk for development of infections.infections.

(c) Patient will need blood cultures and labs (c) Patient will need blood cultures and labs drawn, a fluid challenge is needed to help drawn, a fluid challenge is needed to help with low BP’s. Will need to be started on with low BP’s. Will need to be started on antibiotics. Patient will need to be antibiotics. Patient will need to be monitored closely, VS, I&O’s …monitored closely, VS, I&O’s …


(a)(a) D.G.’s labs cont to show anemia, D.G.’s labs cont to show anemia, neutropenia, renal insuffiency/failure. neutropenia, renal insuffiency/failure. BUN and creatinine have increased and BUN and creatinine have increased and the H&H has falling since previous draw. the H&H has falling since previous draw. The ANC conts to drop.The ANC conts to drop.

(b)(b) Fluids, PRBC transfusion, monitoring of Fluids, PRBC transfusion, monitoring of urine output and VS are needed at this urine output and VS are needed at this time. The transfusion and fluids will help time. The transfusion and fluids will help with hypotension and anemia.with hypotension and anemia.


(a)(a) Pt possibly developing hypoxemia as a Pt possibly developing hypoxemia as a result of the infection process, result of the infection process, hypotension.hypotension.

(b)(b) Need to monitor O2 sats and apply Need to monitor O2 sats and apply oxygen. Need to get orders for CXR and oxygen. Need to get orders for CXR and cont to monitor Vital signs closely.cont to monitor Vital signs closely.


(c)(c) Patient maybe developing pneumonia Patient maybe developing pneumonia and is at an increased risk for ARDS and is at an increased risk for ARDS (acute respiratory distress syndrome). (acute respiratory distress syndrome). The moist cough with rapid resp. rate is The moist cough with rapid resp. rate is good indication of pulmonary good indication of pulmonary involvement. involvement.

The patient also has increased risk of The patient also has increased risk of developing DIC based on the clinical developing DIC based on the clinical presentation and risk factors presented.presentation and risk factors presented.


(a) The clinical presentation leads to the (a) The clinical presentation leads to the diagnosis of DIC (effects every system of diagnosis of DIC (effects every system of the body); the body); Lungs- Lungs- hypoxemia, hypoxemia, hemorrhage, tachypnea hemorrhage, tachypnea Cardiac-Cardiac- acidosis, tachycardia acidosis, tachycardia GI-GI- cramping, cramping, abdominal pain abdominal pain Renal-Renal- hematuria hematuria Integument-Integument- bruising, petechiae bruising, petechiae Mental Mental status changes-status changes- confusion confusion

Answer for Case StudyAnswer for Case Study

(b)(b) A DIC panel results would be helpful at A DIC panel results would be helpful at this time. Lab abnormalities along with this time. Lab abnormalities along with clinical presentation is used to confirm a clinical presentation is used to confirm a diagnosis of DIC. If abnormal results are diagnosis of DIC. If abnormal results are obtained for PT, PTT, platelets, and obtained for PT, PTT, platelets, and fibrinogen, then the D-dimer and FDPs fibrinogen, then the D-dimer and FDPs levels are used to confirm DIC...FDPs levels are used to confirm DIC...FDPs abnormal in 75% and D-dimer in 95%.abnormal in 75% and D-dimer in 95%.

(Otto, 2001)(Otto, 2001)


(a)(a) Based on the lab values, DIC is confirmed for Based on the lab values, DIC is confirmed for the patient. The Platelet count is decreased, the patient. The Platelet count is decreased, the fibrinogen level is decreased, PT and PTT the fibrinogen level is decreased, PT and PTT levels increased and prolonged, FDPs level is levels increased and prolonged, FDPs level is increased and the D-dimer is increased increased and the D-dimer is increased (usually together, levels are 100% specificity (usually together, levels are 100% specificity and sensitive). If a factor assay was done one and sensitive). If a factor assay was done one would expect the levels to show a decrease in would expect the levels to show a decrease in factors VI, VIII, and IX factors VI, VIII, and IX

(Otto, 2001)(Otto, 2001)


(b)(b) The immediate goal for the overall The immediate goal for the overall management of DIC is the treat the underlying management of DIC is the treat the underlying disorder and to stop the patient from actively disorder and to stop the patient from actively bleeding and clotting with the need to give bleeding and clotting with the need to give transfusions and anticoagulation therapy if transfusions and anticoagulation therapy if needed.* Focus of assessments is to monitor needed.* Focus of assessments is to monitor for more bleeding and changes.for more bleeding and changes.

*Heparin therapy has met with controversy for the *Heparin therapy has met with controversy for the treatment of DICtreatment of DIC



(a)(a) Based on the lab values, DG shows Based on the lab values, DG shows slight improvement. The PT and PTT slight improvement. The PT and PTT numbers are better, platelet level has numbers are better, platelet level has increased. increased.

(b)(b) The patient will cont to need to be The patient will cont to need to be monitored very closely. Will need to cont monitored very closely. Will need to cont with treatment, monitor lab values with treatment, monitor lab values frequently. Patient remains critically ill.frequently. Patient remains critically ill.

ReferencesReferencesOtto, Shirley E. (2001). Oncology Otto, Shirley E. (2001). Oncology Nursing. Mosby: St. Louis.Nursing. Mosby: St. Louis.

Porth, Carol M. (2004). Essentials of Porth, Carol M. (2004). Essentials of Pathophysiology: Concepts of AlteredPathophysiology: Concepts of AlteredHealth States. Lippncott Williams &Health States. Lippncott Williams &Wilkins: Philadelphia.Wilkins: Philadelphia.

Web Sites:Web Sites:Pat Bowne, faculty Alverno College Milwaukee Wis.Pat Bowne, faculty Alverno College Milwaukee Wis.

GlossaryGlossaryComplement-Complement-a heat-labile cascade system of at least 20 a heat-labile cascade system of at least 20

glycoproteins in normal serum that interacts to provide glycoproteins in normal serum that interacts to provide manu of the effector functions of humoral immunity and manu of the effector functions of humoral immunity and inflammation, including vasodilation and increases of inflammation, including vasodilation and increases of vascular permeability, facilitation of phagocyte activity vascular permeability, facilitation of phagocyte activity and lysis of certain foreign cells.and lysis of certain foreign cells.

F’s (factors) of Coagulation:F’s (factors) of Coagulation:factors essential to normal factors essential to normal blood-clotting, whose absence, diminution, or excess blood-clotting, whose absence, diminution, or excess may lead to abnormality of clotting mechanisms. There may lead to abnormality of clotting mechanisms. There are 12 Factors-designated by Roman Numerals.are 12 Factors-designated by Roman Numerals.


GlossaryGlossaryFibrinFibrin- an insoluble protein that is essential to clotting of blood, - an insoluble protein that is essential to clotting of blood,

formed from fibrinogen by action of thrombinformed from fibrinogen by action of thrombinFibrinogenFibrinogen- a coagulation factor I, a glycoprotein; administered to - a coagulation factor I, a glycoprotein; administered to

increase the coagulability of the bloodincrease the coagulability of the bloodFibrinolysinFibrinolysin- plasmin, a preparation of proteolytic enzyme formed - plasmin, a preparation of proteolytic enzyme formed

from profibrinolysin(plasminogen); to promote dissolution of from profibrinolysin(plasminogen); to promote dissolution of thrombithrombi

HemostasisHemostasis-the condition in which the external and internal -the condition in which the external and internal environment of a cell remains relatively constantenvironment of a cell remains relatively constant

ThrombinThrombin- an enzyme resulting from activation of prothrombin, - an enzyme resulting from activation of prothrombin, which catalyzes the conversion of fibrinogen to fibrin.which catalyzes the conversion of fibrinogen to fibrin.

ThrombosisThrombosis-formation,development or presences of a thrombus-formation,development or presences of a thrombusThrombus-Thrombus-an aggregation of blood factors, primarily platlets and an aggregation of blood factors, primarily platlets and

fibrin with entrapment of cellular elements, frequently causing fibrin with entrapment of cellular elements, frequently causing vascular obstruction at the point of formation.vascular obstruction at the point of formation.


GlossaryGlossaryActivated PTTActivated PTT- aPTT tests the intrinsic and - aPTT tests the intrinsic and

common pathwayscommon pathwaysD-dimerD-dimer- an antigen formed as a result of plasmin - an antigen formed as a result of plasmin

lysis of cross-linked fibrin clots, documents the lysis of cross-linked fibrin clots, documents the presence of thrombinpresence of thrombin

Fibrin degradation product(FDP)Fibrin degradation product(FDP)- degradation - degradation products increase as plasmin biodegrades products increase as plasmin biodegrades fibrinogen and fibrin,levels are elevated in 85-fibrinogen and fibrin,levels are elevated in 85-100% of patients with DIC100% of patients with DIC

Prothrombin Time(PT)Prothrombin Time(PT)- tests the extrinsic and - tests the extrinsic and common pathwayscommon pathways


GlossaryGlossaryBlood Components:Blood Components: used to correct abnormal used to correct abnormal

homeostasis. Used to correct the clotting homeostasis. Used to correct the clotting deficiencies caused by the consumption of deficiencies caused by the consumption of blood components during the DIC process.blood components during the DIC process.--PlateletsPlatelets: contain platelet factor III, which : contain platelet factor III, which functions as a mechanical plug functions as a mechanical plug --Fresh frozen plasma (FFPs):Fresh frozen plasma (FFPs): used for volume used for volume expansion and contains clotting factors expansion and contains clotting factors V,VIII,XIII and antithrombinIII.V,VIII,XIII and antithrombinIII.

(Otto, S. (2001) Oncology Nursing.)(Otto, S. (2001) Oncology Nursing.)

GlossaryGlossary

Blood Components cont’d:Blood Components cont’d:Packed Red Blood Cells (PRBC’s)Packed Red Blood Cells (PRBC’s): used to : used to increase RBC’s and clotting factors. Used increase RBC’s and clotting factors. Used instead of whole blood to help with fluid instead of whole blood to help with fluid overload and reduce development of overload and reduce development of antibodies.antibodies.Cryoprecpitate:Cryoprecpitate: contains fibrinogen and contains fibrinogen and factor VIII. factor VIII.

(Otto, S. (2001). Oncology Nursing)(Otto, S. (2001). Oncology Nursing)

Thank youThank you

This completes the DIC tutorial. Any and all This completes the DIC tutorial. Any and all comments regarding your learning comments regarding your learning experience are greatly appreciated. experience are greatly appreciated. Please send any correspondence to my Please send any correspondence to my email address listed below:email address listed below:

[email protected]@wi.rr.com

mailto:[email protected]

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