Haemostasis and disseminated intravascular coagulation.

Abstract

Patients with difficulty maintaining haemostasis are frequently seen in critical care units. One coagulopathy which can be triggered by a vast number of clinical conditions is disseminated intravascular coagulation (DIC). DIC is a potentially life-threatening condition resulting from an uncontrolled and excessive activation o f the haemostatic process. Although the diagnosis of DIC is not the responsibility of critical care nurses, it is important that they should be able to recognise the thrombotic and haemorrhagic events associated with the condition, so as to facilitate rapid medical intervention. Unfortunately, patients with DIC display a wide variety of signs and symptoms because o f the diversity of primary disease processes that can precipitate the condition. Furthermore, the haematological changes associated with DIC are similar to those related to chronic liver disease, childbirth and surgery (Kesteven & Saunders 1993). Therefore, the assessment of such patients must be based on each individual's clinical history, current presentation and a variety of laboratory tests. In order to make such an assessment, nurses must first have an understanding of the normal balance between haemostatic components, such as prothrombin, fibrinolytic proteins, platelets and endothelial cells, and the manner in which this balance is altered during DIC. The aim of this paper is to help to achieve this by examining briefly the processes of haemostasis, the conditions and mechanisms that precipitate DIC and identifying the signs that should alert nurses to the development o f this life-threatening condition. VASCULAR ENDOTHELIUM