Disseminated intravascular coagulation laboratory findings: Difference between revisions

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==Overview==
==Overview==
Laboratory findings consistent with the diagnosis of [[DIC]] include decreased platelets, increased [[fibrin degradation products]], increased [[D-dimer]], increased [[bleeding time]], and decreased [[fibrinogen]] levels. Peripheral smear shows [[schistocytes]] and [[RBC]] fragments in ~ 50%, mild [[reticulocytosis]], [[leukocytosis]], and [[thrombocytopenia]] with an increased population of young [[platelets]] (due to increased destruction and turnover). Clotting factors include 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]].
==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:<ref name="pmid25535423">{{cite journal |vauthors=Venugopal A |title=Disseminated intravascular coagulation |journal=Indian J Anaesth |volume=58 |issue=5 |pages=603–8 |date=September 2014 |pmid=25535423 |pmc=4260307 |doi=10.4103/0019-5049.144666 |url=}}</ref>
=== Full blood count: ===
* Decreased [[platelet|platelets]]
 
=== Peripheral smear ===
* [[Schistocytes]] and [[RBC]] fragments in ~ 50%
* Mild [[reticulocytosis]]
* [[Leukocytosis]]
* [[Thrombocytopenia]] with an increased population of young [[platelets]] (due to increased destruction and turnover)


* 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.
=== Clotting factors ===
* [[Thrombocytopenia]] is an almost universal finding.
* Elevated [[prothrombin time]] and [[partial thromboplastin time]]
* 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.
* [[prothrombin|Normal prothrombin]] time and [[partial thromboplastin time]] can be seen in up to 50% of patients (due to higher circulating levels of clotting factors such as [[factor Xa]] and [[thrombin]])<ref name="pmid20614398">{{cite journal |vauthors=Favaloro EJ |title=Laboratory testing in disseminated intravascular coagulation |journal=Semin. Thromb. Hemost. |volume=36 |issue=4 |pages=458–67 |date=June 2010 |pmid=20614398 |doi=10.1055/s-0030-1254055 |url=}}</ref>
* 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).
* Elevated [[fibrin]] and [[fibrinogen]] degradation products
* Fibrin and fibrinogen degradation products, however, are elevated in 80 – 100% of patients.
* Elevated [[D-dimer]] which is more sensitive and specific for DIC<ref name="pmid20950905">{{cite journal |vauthors=Levi M, Meijers JC |title=DIC: which laboratory tests are most useful |journal=Blood Rev. |volume=25 |issue=1 |pages=33–7 |date=January 2011 |pmid=20950905 |doi=10.1016/j.blre.2010.09.002 |url=}}</ref>
*:* 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.
* Reduced [[antithrombin]] levels, which have become a key test for diagnosing and monitoring therapy in [[DIC]]
* The [[D-dimer]], however, is specific for the presence of fibrin degradation, and is thought to be more sensitive and specific for DIC.
* Increased [[bleeding time]]
* Antithrombin levels have become a key test for diagnosing and monitoring therapy in DIC.
* Decreased [[fibrinogen]] level
*:* With thrombin activation, antithrombin is also activated, forming thrombin – antithrombin complexes --> reduced AT levels.
* The main differential is TTP-HUS (thrombotic thrombocytopenic purpura-hemolytic uremic syndrome), which is associated primarily with thrombocytopenia, and minimal effects on fibrin degradation.
*:* The PT and PTT in TTP – HUS are therefore usually normal, and there is little evidence of fibrinolysis and inhibitor consumption.


==References==
==References==

Latest revision as of 02:48, 24 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2]

Overview

Laboratory findings consistent with the diagnosis of DIC include decreased platelets, increased fibrin degradation products, increased D-dimer, increased bleeding time, and decreased fibrinogen levels. Peripheral smear shows schistocytes and RBC fragments in ~ 50%, mild reticulocytosis, leukocytosis, and thrombocytopenia with an increased population of young platelets (due to increased destruction and turnover). Clotting factors include 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.

Laboratory findings

Laboratory findings consistent with the diagnosis of DIC include:[1]

Full blood count:

Peripheral smear

Clotting factors

References

  1. ↑ Venugopal A (September 2014). "Disseminated intravascular coagulation". Indian J Anaesth. 58 (5): 603–8. doi:10.4103/0019-5049.144666. PMC 4260307. PMID 25535423.
  2. ↑ Favaloro EJ (June 2010). "Laboratory testing in disseminated intravascular coagulation". Semin. Thromb. Hemost. 36 (4): 458–67. doi:10.1055/s-0030-1254055. PMID 20614398.
  3. ↑ Levi M, Meijers JC (January 2011). "DIC: which laboratory tests are most useful". Blood Rev. 25 (1): 33–7. doi:10.1016/j.blre.2010.09.002. PMID 20950905.


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