NurseSavvy Cheat SheetDisease
DIC — Disseminated Intravascular Coagulation
Pathophysiology & Risk Factors
DIC is always secondary — it never occurs alone. An underlying trigger activates the clotting cascade systemically, forming microthrombi that consume platelets and clotting factors faster than they can be replaced; once depleted, the patient paradoxically bleeds. This is the consumptive coagulopathy cycle: clot, deplete, bleed.
Consumptive coagulopathy cycle
- TriggerSepsis, OB emergency, trauma, malignancy
- Systemic clotting cascade activation
- Widespread microthrombiMicrovascular thrombosis, organ ischemia
- Platelets + clotting factors consumed
- Paradoxical hemorrhageUncontrolled bleeding once factors depleted
Signs & Symptoms
Oozing from IV/puncture sites Hallmark
Petechiae
Ecchymosis
Hematuria
GI bleeding
Guaiac-positive stools, blood in NG drainageMottled cyanotic digits
Microvascular thrombosisOliguria
Microthrombi-induced organ ischemiaAltered LOC
Diagnostics & Labs
Elevated D-dimer Hallmark
Confirms fibrin breakdown from microclotsLow fibrinogen
Consumed by clottingLow platelet count
ThrombocytopeniaProlonged PT
Prolonged aPTT
Elevated fibrin degradation products
Schistocytes
Fragmented RBCs on smearInterventions & Priorities
Treat the underlying cause Hallmark
Priority — e.g. antibiotics for sepsis; DIC persists until trigger is controlledMonitor for hemorrhage
All puncture sites, mucous membranes, urineMonitor for microvascular thrombosis
Organ ischemia, altered LOC, oliguria, cyanotic digitsReplace consumed blood products
Supportive only after source controlAvoid invasive procedures
No rectal temps — mucosal trauma increases bleedingTreatments & Medications
Cryoprecipitate
Replaces depleted fibrinogenFresh frozen plasma
Replaces clotting factorsPlatelet transfusion
For critically low platelets with active bleedingHeparin
Only in chronic or thrombosis-predominant DIC; not when active hemorrhage dominatesPatient Teaching
Explain monitoring rationale
Frequent labs and bleeding checksExplain transfusion purpose
Replacing consumed clotting factorsReport new bleeding
Gums, urine, stool, bruisingReport Nowescalate immediately
Active hemorrhage
Hemodynamic instability
Progression to hemorrhagic shockOrgan ischemia
Renal failure, ARDS, altered LOCIntracranial bleed
Sudden neuro change, severe headacheClinical Pearl
DIC clots and bleeds at the same time — low platelets, low fibrinogen, high D-dimer, prolonged PT/PTT. Fix the trigger, because Death Is Coming if you don't find the cause.