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DIC Case Study

D.G. is a 48-year-old man who underwent an allogenic stem cell transplant for acute myelogenous leukemia. He developed fever and hypotension and his labs showed pancytopenia and renal dysfunction, indicating infection and transplant complications. Despite antibiotics and fluids, his condition deteriorated with respiratory distress, bleeding, and disseminated intravascular coagulation. Ultimately multi-organ failure from sepsis led to his death.

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281 views7 pages

DIC Case Study

D.G. is a 48-year-old man who underwent an allogenic stem cell transplant for acute myelogenous leukemia. He developed fever and hypotension and his labs showed pancytopenia and renal dysfunction, indicating infection and transplant complications. Despite antibiotics and fluids, his condition deteriorated with respiratory distress, bleeding, and disseminated intravascular coagulation. Ultimately multi-organ failure from sepsis led to his death.

Uploaded by

Robert
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Case Study

D.G.,a 48-year-old, is 30 days post matched unrelated allogenic stem


cell transplant for Acute Myelegenous Leukemia. His Lab work is as
follows:
WBC
480 Sodium 130
Hgb

10 Potassium

3.7

Hct

27 BUN

16

Plts

35

Creatinine

1.4

(a) Based on the above lab values, what risk factors does D.G. have?
The next morning after labs are drawn, D.G. developed a fever of
101.2 and BP fell to 98/60 (normally 130/76).
(b)What may be the cause of the fever and low BP?
(c)What interventions should you as primary RN take at this time?

Case Study cont.


D.G. is started on Vanco and Primaxin and given 1 liter fluid bolus
over 2 hours. Blood cultures were drawn prior to antibiotic RX. His
fever decreased to 99.8 and BP increased to 108/70.
Overnight D.G. again became febrile to 102.4 with drop in BP to
70s/50s. Labs were drawn and fluids started at 500cc/hr. Labs
values were significant:
WBC

474

Hgb

9.1 Potassium 3.8

Hct

25BUN

Sodium 135
35

Plts 20
Creatinine
2.8
(a)What do the above lab values say about D.G. status?
(b)What interventions should be taken?

Case Study
MD orders 2 units of PRBC to be infused over 4 hours. During infusion
BP increased to 90/48 and he continues to be febrile at 101.0.
D.G. is becoming more confused, complaining of GI pain and cramping,
developing a moist cough with rapid respiratory rate.

(a)What maybe causing the new symptoms?


(b)What interventions do you take at this time?
(c)What maybe the underlying process? What else is he at risk for?

Case Study cont.


O2 sats on RA measure 84% and lung sounds are coarse
throughout. STAT ABGs and CXR are done. X-ray results show
diffuse consolidation and the ABGs demonstrate respiratory
acidosis with hypoxemia. D.G. is placed on oxygen, O2 sats
improve to 91%. Urine and stool output at this time test heme
positive. You also note he has small lower extremity bruising and
scattered petechia. A bronchoscophy is ordered and performed.
Results show diffuse alveolar hemorrhage.
(a) Based on D.G. history and the current clinical picture, what are
potential causes for symptoms (GI, Respiratory, GU)?
(b) What information would be useful at this time for diagnosis?

Case Study
MD orders CBC and coagulation screen. The results are as follows:
WBC
<100 PT
34 sec
Hgb
Hct
Plts

9
23

PTT
72
Fibrinogen <100

12
FSP
D-dimer
>500

>1000

(c)What secondary process is possibly occurring based on above values?


(d)What interventions are appropriate? What should be the focus of your
assessments?

Case Study

D.G. Continues to be hypotensive. Lung sounds remain


course, hemoptysis develops and CXR continues with
diffuse consolidation. Urine and stool remain heme
positive. After transfusion, labs redrawn. Values as
follows:
Plts 22 Pt
28
Hct
26 PTT
54
Hgb
10 Fibrin
<100
FSP
>1000
(a)What is the results of treatment based on above values?
(b)What interventions should be done?

Case Study
D.G. status continues to deteriorate and needed to be
intubated 2 days after developing DIC. The sepsis
remained unresolved and he went into acute renal
failure. Family decided not to dialyze due to the multiorgan involvement. D.G. expired 2 days later from the
gram neg sepsis and secondary DIC.

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