How is disseminated intravascular coagulation (DIC) diagnosed?

Updated: Oct 28, 2019
  • Author: Muhammad A Mir, MD, FACP; Chief Editor: Perumal Thiagarajan, MD  more...
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Answer

Answer

The diagnosis of DIC is based on both clinical suspicion of DIC and a combination of laboratory test findings. Patients with the following known underlying causes should be carefully observed for indications of the development of DIC (eg, microthrombi, bleeding):

Underlying causes of DIC sepsis/infection are as follows:

  • Malignancy

  • Trauma

  • Aortic aneurysm

  • Cerebral injury

  • Hepatic surgery

  • Burn injury

  • Hypothermia

  • Massive transfusion

  • Prolonged surgery

Evidence of ongoing consumption of coagulation proteins from laboratory testing includes decreasing fibrinogen levels and platelet counts. PT and aPTT may both be prolonged. Peripheral smear may show schistocytes. Increasing plasma levels of D-dimer, fibrinogen split products (FSP), and soluble fibrin monomer (FM), are found as DIC progresses. Elevated D-dimer levels reflect both thrombin and plasmin production. [65] These studies must be repeated to confirm the diagnosis of DIC and to monitor therapeutic progress. [73]

Circulating factors can be used as markers of prognosis in DIC. In 1999, Kotajima et al showed that levels of plasma thrombomodulin, a high-affinity thrombin receptor on vascular endothelial cells, were significantly higher in nonsurvivors of DIC than in survivors (thrombomodulin 3.1+/-1.52 FU/mL vs 8.1+/-3.89 FU/mL). [74]


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