From the Guidelines
DIC labs, or Disseminated Intravascular Coagulation laboratory tests, are diagnostic blood tests used to identify and monitor DIC, and typically include platelet count, fibrinogen, PT, and APTT, with measurement of fibrinogen degradation products or D-dimers being useful as well 1. These tests are essential for early detection of DIC, a condition that carries a considerable mortality rate and is difficult to reverse once established.
- The key laboratory evidence of DIC includes:
- Prolongation of PT and APTT beyond that expected by dilution
- Significant thrombocytopenia
- Fibrinogen of <1.0 g litre-1
- Frequent estimation of these labs is strongly recommended, especially in patients at risk of DIC, such as those with prolonged hypoxia or hypovolaemia, cerebral or extensive muscle damage, or hypothermia after infusion of cold resuscitation fluids 1.
- Serial measurements of these labs are important for monitoring treatment effectiveness, which focuses on addressing the underlying cause while supporting the patient with blood products, such as platelets, FFP, and cryoprecipitate, as needed 1.
- Early detection through these laboratory markers is crucial for improving outcomes in this potentially life-threatening condition.
From the Research
Definition and Diagnosis of DIC
- Disseminated intravascular coagulation (DIC) is a complex condition characterized by widespread activation of coagulation, leading to fibrin deposition in the vasculature, organ dysfunction, consumption of clotting factors and platelets, and life-threatening hemorrhage 2.
- The diagnosis of DIC should encompass both clinical and laboratory information, using the International Society for Thrombosis and Haemostasis (ISTH) DIC scoring system for objective measurement 3.
- Laboratory tests for DIC include prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP), and D-dimer, with the combination of FDP and D-dimer having the highest diagnostic efficiency 4.
Laboratory Tests for DIC
- The FDP and D-dimer combination has a diagnostic efficiency of 95%, with sensitivity of 91% and specificity of 94% 4.
- Other laboratory tests, such as PT, PTT, thrombin time, platelet count, and fibrinogen, have lower sensitivity and specificity for DIC diagnosis 4, 5.
- The Japanese Association for Acute Medicine (JAAM) diagnostic criteria for DIC include a combination of laboratory tests, such as PT, PTT, fibrinogen, and FDP, to diagnose overt and non-overt DIC 6.
Diagnostic Criteria for DIC
- The ISTH and JAAM have published diagnostic criteria for DIC, which include a combination of clinical and laboratory findings 3, 6.
- The JAAM diagnostic criteria have excellent sensitivity for mortality but low specificity, highlighting the need for careful evaluation of patients with suspected DIC 6.
- Early diagnosis and treatment of DIC are crucial to improve outcomes, and the use of hemostatic molecular markers may aid in rapid diagnosis 6.