DIC — Disseminated Intravascular Coagulation

Disseminated intravascular coagulation is a secondary condition — it never occurs alone. An underlying trigger (sepsis, trauma, obstetric complications like abruptio placentae, malignancy, massive transfusion) activates the clotting cascade systemically. Tiny clots form throughout the microvasculature, consuming platelets and clotting factors faster than the body can replace them. Once those factors are depleted, the patient paradoxically shifts into uncontrolled bleeding. This is the consumptive coagulopathy cycle: clot → deplete → bleed. Lab findings reflect both sides: platelets drop, fibrinogen drops, PT/PTT rise, and D-dimer elevates (the hallmark — it confirms fibrin breakdown from all those microclots). Nursing priorities center on identifying the underlying cause, monitoring for both microvascular thrombosis (organ ischemia, altered LOC, oliguria, cyanotic digits) AND hemorrhage (petechiae, oozing from IV sites, hematuria, guaiac-positive stools). Treatment targets the trigger. Heparin may be used in select chronic or thrombosis-predominant DIC — counterintuitive but logical because it interrupts the clotting cascade that drives consumption. Blood products (cryoprecipitate for fibrinogen, FFP for clotting factors, platelets) replace what's been consumed.