Describe the general principles of diagnostics in DIC.
Suspect DIC based on clinical features and typical underlying diseases; especially in patients with clinical deterioration.
Laboratory studies vary depending on the subtype, underlying disorders, and stage of DIC.
Challenges
No single test can reliably rule out DIC.
Nonsymptomatic DIC may only become apparent after specific laboratory screening.
DIC may already be irreversibly decompensated by the time diagnosis is made using scoring systems.
Describe the coagulation panel needed and associated findings.
Coagulation panel: Monitor frequently (e.g., every 6–8 hours or until stable or improving).
↑ aPTT, ↑ PT
↓ Fibrinogen: indicative of associated hyperfibrinolysis
Markers of fibrin breakdown: ↑ D-dimer or other FDPs
↑ Bleeding time
Coagulation factors: ↓ factor V and ↓ factor VIII
Describe the CBC and blood smear.
CBC and blood smear
↓ Platelet count: due to consumption and/or bleeding
↓ Hct: occurs with bleeding
Schistocytes: indicative of microangiopathic hemolytic anemia
Other tests of organ function (e.g., renal function tests, liver chemistries): Order depending on clinical picture and underlying conditions.
List DDs.
Decreased production of platelets and clotting factors
Severe hepatic dysfunction
Vitamin K deficiency
Bone marrow suppression
Hemophilia
Increased destruction of platelets and clotting factors [15]
Thrombotic thrombocytopenic purpura
Immune thrombocytopenic purpura
Heparin-induced thrombocytopenia
Acute hemolytic anemia
Hemolytic uremic syndrome
Increased consumption of platelets and clotting factors
DVT/pulmonary embolism
Surgery
Infections
Increased loss of platelets and clotting factors
Massive blood transfusio
DD and laboratory findings table.
Last changed2 years ago
