Disseminated Intravascular Coagulation It is a paradox in the hemostatic sequence and is characterized by widespread coagulation and bleeding in the vascular

compartment. DIC is not a disease but a sign of an underlying condition. DIC may be triggered by sepsis, trauma, cancer, shock, abruption placentae, toxins or allergic reactions. Pathophysiology In DIC, normal hemostatic mechanisms are altered. The inflammatory response generated by the underlying disease initiates the process of coagulation within the vasculature as a result of unregulated generation of thrombin which then leads to systemic intravascular fibrin deposition. The microthrombi that result cause vessel occlusion and tissue ischemia. Multiple organ failure my ensue. Clot formation consumes all available coagulation proteins and platelets, normal coagulation is disrupted and severe hemorrhage result.. Clinical Manifestation Signs and Symptoms of Excessive Blood Clotting In DIC, blood clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels and cause the following signs and symptoms:

Chest pain and shortness of breath due to blood clots forming in the blood vessels in your lungs and heart. Pain, redness, warmth, and swelling in the lower leg due to blood clots forming in the deep veins of your leg. Headaches, speech changes, paralysis (an inability to move), dizziness, and trouble speaking and understanding due to blood clots forming in the blood vessels in your brain. These signs and symptoms may suggest a stroke. Heart attack and lung and kidney problems due to blood clots lodging in your heart, lungs, or kidneys. These organs may even begin to fail. Signs and Symptoms of Bleeding

In DIC, the increased clotting activity uses up the platelets and clotting factors in the blood. As a result, serious bleeding can occur. DIC can cause internal bleeding and external bleeding. Internal Bleeding Internal bleeding can occur in your body's organs, such as the kidneys, intestines, and brain. This bleeding can be life threatening. Signs and symptoms of internal bleeding include:

Blood in your urine from bleeding in your kidneys or bladder. Blood in your stools from bleeding in your intestines or stomach. Blood in your stools can appear red or as a dark, tarry color. (Taking iron supplements also can cause dark, tarry stools.) Headaches, double vision, seizures, and other symptoms from bleeding in your brain.

External Bleeding In DIC, external bleeding can occur underneath or from the skin, such as at the site of cuts or an intravenous (IV) needle. External bleeding also can occur from the mucosa (the tissue that lines some organs and body cavities, such as your nose and mouth). External bleeding may cause purpura or petechiae. Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin. Other signs of external bleeding include:

Prolonged bleeding, even from minor cuts. Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from brushing your teeth. Heavy or extended menstrual bleeding in women.

References: Bare, B.G., Cheever, K.H., Hinkle, J.L., and Smeltzer, S.C. (2010). Brunner & Suddarths texbook of medical and surgical nursing. 12 ed. Philadelphia: Lippincott Williams & Wilkins. Porth, CM. (2005).Pathophysiology: Concepts of Altered Health States. (7th ed.) http://www.nhlbi.nih.gov/health/dci/Diseases/dic/dic_what.html