Clotless Clara — Disseminated Intravascular Coagulation
Bleeding AND clotting at once — oozing IV sites plus low platelets and fibrinogen
Clara's IV sites won't stop oozing and her gums bleed when the nurse checks her mouth. Her fingers are turning dusky at the same time her labs show she is bleeding out.
Clara developed sepsis after a complicated delivery, and her clotting system has spun out of control. In DIC, widespread clotting consumes platelets and clotting factors so fast that the body can no longer form clots where it needs to — the result is bleeding from every IV site, incision, and mucous membrane at the same time tiny clots choke off blood flow to organs. Treating the underlying cause (sepsis) while supporting clotting factors with blood products is the only way out.
Read Clotless Clara's full story →The story arc
The setup
A severe postpartum infection triggers Clara's septic response, activating the clotting cascade throughout her bloodstream.
The turn
Tiny clots begin forming throughout Clara's small vessels, using up platelets and clotting factors as they go.
The crisis
Clara oozes blood from every IV site and her gums, bruises appear where no one touched her, and her fingertips turn dusky and cool. Platelets are 38,000/mm³, fibrinogen is 80 mg/dL, D-dimer is markedly elevated.
The save
The care team treats the underlying sepsis with antibiotics, transfuses fresh frozen plasma, cryoprecipitate, and platelets to replace what has been consumed, and the nurse minimizes needle sticks and applies prolonged pressure to every puncture site.
NCLEX study section — Disseminated Intravascular Coagulation
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Critical Care
Take this chapter into practice questions on the same topic.