Disseminated intravascular coagulation laboratory findings: Difference between revisions

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==Overview==
==Overview==
==Laboratory findings==
==Laboratory findings==
Although numerous [[blood test]]s are often performed on patients prone to DIC, the important measures are: [[full blood count]] (especially the [[platelet]] count), [[fibrin degradation product]]s or [[D-dimer]] tests (markers of [[fibrinolysis]]), [[bleeding time]] and [[fibrinogen]] levels. Decreased platelets, elevated FDPs or D-dimers, prolonged bleeding time and decreased fibrinogen are markers of DIC. In general;
Laboratory findings consistent with the diagnosis of [[DIC]] include:


* The diagnosis of DIC is suggested when the appropriate clinical picture (hemorrhage and thrombosis with end-organ dysfunction) is accompanied by lab evidence of procoagulant activation, fibrinolytic activation, and inhibitor consumption.
 
* [[Thrombocytopenia]] is an almost universal finding.
=== Full blood count: ===
* The peripheral smear will reveal schistocytes and RBC (red blood cell) fragments in ~ 50%, and the absence of schistocytes does not rule out DIC. Most patients will have a mild reticulocytosis and leukocytosis, as well as thrombocytopenia with an increased population of young platelets (due to increased destruction and turnover). Pathologically, early signs include platelet-rich microthrombi, which are then replaced by fibrin-rich microthrombi.
* Decreased [[platelet|platelets]]
* Although one would think that the PT and PTT ([[prothrombin]] time and [[partial thromboplastin time]]) should uniformly be elevated in DIC, this is not the case, with up to 50% of patients having normal values (due to higher circulating levels of clotting factors such as factor Xa and thrombin).
* [[fibrin degradation product]]s or [[D-dimer]] tests (markers of [[fibrinolysis]])
* Fibrin and fibrinogen degradation products, however, are elevated in 80 – 100% of patients.
* [[bleeding time]] and [[fibrinogen]] levels.  
*:* High FDPs, however, are not specific and can be elevated in any state associated with elevated plasmin levels such as PE/DVT (pulmonary embolism/deep vein thrombosis), liver or renal disease, in patients s/p (status post) surgery, and in women on oral contraceptives.
 
* The [[D-dimer]], however, is specific for the presence of fibrin degradation, and is thought to be more sensitive and specific for DIC.
=== Peripheral smear ===
* Antithrombin levels have become a key test for diagnosing and monitoring therapy in DIC.
* [[Schistocytes]] and [[RBC]] fragments in ~ 50%  
*:* With thrombin activation, antithrombin is also activated, forming thrombin – antithrombin complexes --> reduced AT levels.
* Mild [[reticulocytosis]] 
* The main differential is TTP-HUS (thrombotic thrombocytopenic purpura-hemolytic uremic syndrome), which is associated primarily with thrombocytopenia, and minimal effects on fibrin degradation.
* [[Leukocytosis]]
*:* The PT and PTT in TTP – HUS are therefore usually normal, and there is little evidence of fibrinolysis and inhibitor consumption.
* [[Thrombocytopenia]] with an increased population of young [[platelets]] (due to increased destruction and turnover)
 
=== Clotting factors ===
* [[prothrombin|Normal prothrombin]] time and [[partial thromboplastin time]] in up to 50% of patients (due to higher circulating levels of clotting factors such as [[factor Xa]] and [[thrombin]])
* Elevated [[fibrin]] and [[fibrinogen]] degradation products
* [[D-dimer]] more sensitive and specific for DIC.]
* [[Antithrombin]] levels have become a key test for diagnosing and monitoring therapy in [[DIC]].
* Reduced [[Antithrombin]] levels.


==References==
==References==

Revision as of 17:02, 19 September 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Laboratory findings

Laboratory findings consistent with the diagnosis of DIC include:


Full blood count:

Peripheral smear

Clotting factors

References


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