From the Guidelines
Diagnosis of Disseminated Intravascular Coagulation (DIC) should be based on the International Society on Thrombosis and Haemostasis (ISTH) scoring system, which requires a score of 5 or higher for overt DIC diagnosis, as recommended by the most recent study 1.
Key Laboratory Criteria
The key laboratory criteria for DIC diagnosis include:
- Platelet count (<100,000/μL)
- Elevated fibrin degradation products or D-dimer (>upper limit of normal)
- Prolonged prothrombin time (>3 seconds above normal)
- Reduced fibrinogen levels (<100 mg/dL)
Underlying Conditions
An underlying condition known to precipitate DIC must be present, such as:
- Sepsis
- Trauma
- Malignancy
- Obstetric complications
Clinical Manifestations
The diagnosis should incorporate both laboratory abnormalities and clinical manifestations, which may include:
- Bleeding from multiple sites
- Organ dysfunction
- Thrombotic complications
Serial Laboratory Measurements
Serial laboratory measurements are essential as DIC is a dynamic process, and early diagnosis is crucial for timely intervention, which focuses on treating the underlying cause while providing supportive care for coagulation abnormalities, as highlighted in 1 and 1.
Importance of Endothelium-Related Biomarkers
Recent studies, such as 1, suggest that endothelium-related biomarkers may play a critical role in the early detection and management of DIC, and their inclusion in the diagnostic criteria may improve outcomes.
Clinical Correlation
The paradoxical nature of DIC, presenting with both bleeding and clotting, makes clinical correlation with laboratory findings particularly important for accurate diagnosis, as emphasized in 1.
From the Research
Diagnostic Criteria for DIC
The diagnosis of Disseminated Intravascular Coagulation (DIC) is a complex process that involves both clinical and laboratory information 2. The International Society for Thrombosis and Haemostasis (ISTH) DIC scoring system provides an objective measurement of DIC, which correlates with key clinical observations and outcomes 2.
Laboratory Tests for DIC Diagnosis
Several laboratory tests are used to diagnose DIC, including:
- Prothrombin time (PT) and partial thromboplastin time (PTT) 3
- Fibrinogen/fibrin degradation products (FDP) and D-dimer 3
- Fibrinogen and platelet count 3
- Antithrombin 3
Diagnostic Criteria
The diagnostic criteria for DIC have been published by the International Society on Thrombosis and Haemostasis (ISTH) and the Japanese Association for Acute Medicine (JAAM) 4. These criteria include:
- The ISTH DIC scoring system 2
- The JAAM diagnostic criteria, which demonstrated excellent sensitivity for mortality but low specificity 4
- The Japanese Ministry of Health, Labor and Welfare (JMHLW) criteria, which are modified versions of the JAAM diagnostic criteria 4
Challenges in DIC Diagnosis
There are several challenges in diagnosing DIC, including:
- The lack of sensitive biomarkers 5
- The fact that the clinical manifestations of DIC are not sensitive or specific 5
- The need for personalized diagnostic criteria based on etiology, reflecting pathophysiological mechanisms, and establishing clear cut-off values for parameters 5
Importance of Early Diagnosis and Treatment
Early diagnosis and treatment of DIC are crucial to improve patient outcomes 4. The use of hemostatic molecular markers is necessary to make an early and rapid diagnosis, and the administration of recombinant activated protein C or recombinant thrombomodulin may improve mortality 4.
Key Considerations
Key considerations in the diagnosis and treatment of DIC include:
- The need for repeated tests to monitor the dynamically changing scenario based on laboratory results and clinical observations 2
- The importance of treating the underlying condition 2
- The use of transfusion of platelets or plasma (components) in patients with DIC, which should not be primarily based on laboratory results and should be reserved for patients who present with bleeding 2