What is the Japanese Association for Acute Medicine (JAAM) diagnostic algorithm and scoring system for disseminated intravascular coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Despite the demonstrable utility of the ISTH scoring system for diagnosing overt DIC, concerns have been expressed about its validity for identifying nonovert DIC. In response to these concerns, the Japanese Association for Acute Medicine (JAAM) developed a diagnostic algorithm and scoring system designed for use in critically ill patients (see Table 4 below). [67]

Table 4. Japanese Association for Acute Medicine (JAAM) Scoring System for DIC (Open Table in a new window)

Clinical conditions that should be ruled out

Thrombocytopenia

Dilution and abnormal distribution

Massive blood loss, massive infusion

ITP, TTP-HUS, HIT, HELLP syndrome

Disorders of hematopoiesis

Liver disease

Hypothermia

Spurious laboratory results

Diagnostic algorithm for SIRS

Temperature >38°C or < 36°C

Heart rate >90 beats/min

Respiratory rate >20 breaths/min or PaCO2 < 32 mm Hg (< 4.3 kPa)

WBC count >12,000 cells/µL, < 4000 cells/ µL, or 10% immature (band) forms

Diagnostic algorithm

SIRS criteria

Score

>3

1

0-2

0

Platelet count (× 109/L)

 

< 80 or >50 % decrease within 24 hours

3

>80 and < 120 or >30% decrease within 24 hours

1

>120

0

Prothrombin time (value of patient/normal value)

 

>1.2

1

< 1.2

0

Fibrin/FDPs (mg/L)

 

>25

3

>10 and < 25

1

< 10

0

Diagnosis

4 points or more

DIC

DIC = disseminated intravascular coagulation; FDP = fibrin degradation product; HELLP = hemolysis, elevated liver enzymes, low platelet count; HIT = heparin-induced thrombocytopenia; HUS = hemolytic uremic syndrome; ITP = idiopathic thrombocytopenic purpura; PaCO2 = partial pressure of carbon dioxide in arterial blood; SIRS = systemic inflammatory response syndrome; TTP = thrombotic thrombocytopenic purpura; WBC = white blood cell.

This system has been prospectively validated and has been found to be capable of diagnosing DIC earlier than previous methods could. Furthermore, evidence suggests that early identification of DIC using this scoring system, as well as early and aggressive treatment of DIC and the underlying disorder, can lead to improvements in patient outcome and reductions in mortality. [67]


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