A patient with disseminated intravascular coagulation (DIC) is not responding to infusions of fresh-frozen plasma and platelets. Which interventions might be indicated for this patient?
Select all that apply.
1. beginning heparin injections
2. beginning heparin infusion
3. administering factor VIII infusion
4. beginning normal saline infusion
5. preparing for a bone marrow biopsy
Correct Answer: 1, 2
When bleeding is the major manifestation of disseminated intravascular coagulation (DIC), fresh-frozen plasma and platelet concentrates are given to restore clotting factors and platelets. Heparin may be administered. Heparin interferes with the clotting cascade and may prevent further clotting factor consumption due to uncontrolled thrombosis. It is used when bleeding is not controlled by plasma and platelets, as well as when the patient has manifestations of thrombotic problems such as acrocyanosis and possible gangrene. Long-term heparin therapy, by injection or continuous infusion with a portable pump, may be necessary for patients with chronic DIC. Neither normal saline nor Factor VIII would help with the clotting. The diagnosis has already been determined, and bone marrow aspiration would not be indicated.
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