From the Guidelines
The parameter for Disseminated Intravascular Coagulation (DIC) is primarily based on laboratory tests including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen levels, with prolongation of PT and APTT, significant thrombocytopenia, and fibrinogen of <1.0 g litre-1 being highly suggestive of DIC. When evaluating for DIC, it is crucial to consider the clinical context, including the presence of prolonged hypoxia or hypovolaemia, cerebral or extensive muscle damage, and hypothermia after infusion of cold resuscitation fluids, as these conditions increase the risk of developing DIC 1. Key laboratory tests for diagnosing DIC include:
- Platelet count
- Prothrombin time (PT)
- Activated partial thromboplastin time (aPTT)
- Fibrinogen levels Additionally, measurement of fibrinogen degradation products or D-dimers may be useful in supporting the diagnosis of DIC 1. The treatment of DIC involves addressing the underlying cause and supporting coagulation with platelets, fresh frozen plasma (FFP), and cryoprecipitate, given in sufficient dosage to avoid circulatory overload 1. Monitoring these parameters serially is essential, as DIC is a dynamic process that can rapidly evolve, and early detection and treatment are critical to improving outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Parameters for DIC
The parameters for Disseminated Intravascular Coagulation (DIC) can be identified through various laboratory tests and clinical observations. Some key parameters include:
- Platelet count: A platelet count of <50 x 10(9)/l is considered a critical threshold for transfusion in patients with DIC and bleeding or at high risk of bleeding 2
- Prothrombin time (PT) and activated partial thromboplastin time (aPTT): Prolonged PT and aPTT are indicative of coagulopathy in DIC 2, 3
- Fibrinogen level: Severe hypofibrinogenemia (<1 g/l) may require treatment with fibrinogen concentrate or cryoprecipitate 2
- D-dimer and fibrin degradation products (FDP): Elevated levels of D-dimer and FDP are sensitive markers of DIC 3
- Antithrombin level: Low antithrombin levels may indicate severe DIC and poor prognosis 3
Diagnostic Criteria
The International Society for Thrombosis and Haemostasis (ISTH) DIC scoring system provides an objective measurement of DIC, incorporating both clinical and laboratory information 2. The scoring system correlates with key clinical observations and outcomes, and repeated tests are necessary to monitor the dynamically changing scenario based on laboratory results and clinical observations 2.
Laboratory Tests
Laboratory tests used to diagnose DIC include: