Disseminated Intravascular Coagulation, Blood, and Transfusions

What is disseminated intravascular coagulation (DIC)?

Accelerated clotting throughout small blood vessels that consumes platelets and clotting factors, causing organ ischemia and uncontrolled bleeding.

Why can DIC cause organ failure?

Widespread clots block small blood vessels.

Why does DIC cause bleeding?

Excessive clotting consumes available platelets and clotting factors.

What happens to PT/PTT in DIC?

They increase.

Why do PT/PTT increase in DIC?

Available clotting factors and platelets are depleted/consumed.

What happens to D-dimer in DIC?

It increases.

Why does D-dimer increase in DIC?

Many clots are being broken down.

What happens to fibrinogen in DIC?

It decreases.

Why does fibrinogen decrease in DIC?

It is consumed by excessive clot formation.

What happens to platelet count in DIC?

It decreases.

What treatments are listed for DIC?

Fresh frozen plasma, whole blood, anticoagulants to prevent ischemic complications from excessive clotting, and IV fluids to increase vascular volume.

What is fresh frozen plasma (FFP) rich in?

Clotting factors.

What is FFP used to treat?

Acute clotting disorders.

Which lab should be reviewed after FFP administration?

Prothrombin time (PT).

What is the desired PT response after FFP?

PT should decrease.

What lab is reviewed after platelet administration?

Platelet count.

What lab is reviewed after packed RBC administration according to the notes?

Hematocrit.

Is ABO compatibility required for FFP?

Yes, according to the ATI notes.

What plasma types can a type B patient receive according to the ATI example?

Type B or AB plasma.

What should the nurse do if incompatible plasma is infusing?

Remove/stop the plasma immediately and start 0.9% sodium chloride with new tubing.

What is the FIRST action if a patient develops itching and hives during PRBC transfusion?

Stop the transfusion.

After stopping a transfusion reaction, how should IV access be maintained?

Start 0.9% sodium chloride using a new IV administration set.

What additional actions are listed after a transfusion reaction?

Send the blood container/tubing to the blood bank and obtain a urine sample when indicated to assess for hemoglobin.

What is the first action listed when preparing to transfuse PRBCs?

Witness informed consent.

What IV solution should be used with blood products?

0.9% sodium chloride.

What blood-product safety checks are listed?

Check provider order, patient ID, product, compatibility, and perform required verification with another nurse.

What should be obtained before transfusion begins?

Pretransfusion vital signs.

What fluid should be administered in hypovolemic shock while waiting for blood?

0.9% sodium chloride.

Why is 0.9% NS appropriate in hypovolemic shock?

It is an isotonic crystalloid that replaces circulating volume and is the solution listed for use with blood products.

Why is 0.45% NS not appropriate for volume replacement in this example?

It is hypotonic and the notes warn it can contribute to RBC lysis due to osmotic movement.

Why are hypertonic dextrose solutions not used for this volume-replacement purpose in the notes?

They are not appropriate for restoring circulating volume in this scenario.

What complication can develop after many blood transfusions?

Iron toxicity/hemosiderosis.

Why can repeated transfusions cause hyperkalemia?

Stored blood releases potassium as RBCs hemolyze.

Why can repeated transfusions cause hypocalcemia?

Citrate in transfused blood binds calcium.