My 87 year old mother has late Stage 4 Adenocarcinoma. She has a large pleural effusion on one side and the Dr. recommended a Thoracentesis procedure to help her breathing. When the radiologist inserted the needle, she immediately had extreme pain and was screaming. They were only able to draw out 200 cc before pulling out the needle. My guess is that the Dr. hit a blood vessel or a nerve when he inserted the needle. We went home and about 6 hours later, her nose started bleeding and we had difficulty getting it to stop. After trying for hours, I was helping her to the bathroom and I noticed that the back of her sweater was all bloody where the needle entry point was. I called 911 and we ended up the in ER, where the bleeding stopped. They checked her blood counts and coagulation factors. Platelets were very low and her INR, PT, PTT were all very high at that time. Earlier in the day, prior to the thoracentesis, they checked her coagulation factors and they were normal.
The doctors decided to try transfusions to restore her clotting abilities. They gave her red blood, cryo, platelets over a 4 day period. It boosted her platelets to around 60k, but then fell the following day when they did not give a transfusion to boost her platelets. The clotting times also dropped to near normal after getting a transfusion, but then dropped back the following day with no transfusion. They have diagnosed her with DIC and recommended stopping the transfusions because they are just a temporary fix. The blood cultures have come back negative for infection so far. They say that they cannot treat the underlying lung cancer and are recommending hospice.
Is it possible for trauma from a thoracentesis to cause a DIC? Is 4 days enough of a period to know if the transfusions are helping a patient? Are there any other treatments for DIC that should be considered?
Reply # - September 19, 2012, 06:49 AM
Reply To: Disseminated Intravascular Coagulation
Paul, welcome to Grace. I'm so sorry you have had to come here for your mom but we can help put the pieces together.
The NIH med library explains the causes of DIC including cancer itself,
"Causes
Normally when you are injured, certain proteins in the blood become activated and travel to the injury site to help stop bleeding. However, in persons with DIC, these proteins become abnormally active. This often occurs due to inflammation, infection, or cancer." http://www.nlm.nih.gov/medlineplus/ency/article/000573
I will contact a doctor for more input. You should hear back within 12 hours. In the meantime this is a link to a discussion on hospice. http://cancergrace.org/cancer-treatments/2012/08/12/hospice-is-help/ I know it will be difficult but also i hope you find it helpful.
Janine
Forum moderator
Reply # - September 19, 2012, 05:18 PM
Reply To: Disseminated Intravascular Coagulation
Hi Paul, I am so sorry to hear about your mother. While is not possible to really know what is happening with your mother without seeing her myself, I can talk a little about (disseminated intravascular coagulation) DIC and lung cancer. DIC is essentially a process where the body's clotting system is revved up and working full throttle, while the other system that breaks down clots is also working overdrive at the same time. It uses up all of the body's clotting and clot-busting supplies (proteins) so in the end the patient is predisposed to either bleeding or excessive clotting because there is nothing left to stop it.
DIC can occur in response to many things, like infection as your mother's doctors may have mentioned. However, it is also common with advanced stage cancer including lung cancer. Much of the time the DIC is minor and not of major consequence, perhaps just causing some lab abnormalities like low platelets. However, sometimes it can be much more serious, and once major bleeding starts it can be very hard to stop it. Transfusions of blood, plasma, and platelets only work for a short while and then get used up. The only "cure" for DIC is to fix the underlying problem that is causing it. If the patient has an infection, for example, then treating the infection and supporting the patient until they recover can sometimes allow the body to recover. For someone with metastatic cancer as the cause, though, it usually isn't possible to "fix" the cancer and so it is a tough situation without a lot of good treatments.
As for your specific question, trauma and injury can cause DIC, and if a patient had low-level DIC already and then had a trauma that used up the remaining clotting factors that might concieveably make it worse. I don't think I can answer if 4 days of transfusions is enough to tell if things are going to improve, it all depends on the cause. I'm sorry you both are stuck in such a tough situation.
Reply # - September 19, 2012, 07:45 PM
Reply To: Disseminated Intravascular Coagulation
I agree with all of Dr. Pennell's great explanation and other comments here. The key point that is drilled home in treating DIC is that "you need to treat the underlying problem", which may be easier said than done with advanced cancer. I would find it unlikely for a thoracentesis (which is done in a controlled way, with a reasonably small needle) to be associated with enough trauma to cause DIC, or at least if that happened, it would be in the setting that the cancer itself has already set the stage so much that a person was predisposed to a full-blown DIC picture with very little further insult. I suppose if it caused lung collapse and some terrible complications with that, DIC could result, but I would find it far more likely that her situation was primed for DIC already and perhaps passed a critical point with very little instigation.
Good luck.
-Dr. West