Kobayashi et al listed criteria for the diagnosis of disseminated intravascular coagulation (DIC). This can help identify patients who may require closer monitoring and more aggressive management. The authors are from Gunma University in Maebashi, Japan.
Parameters:
(1) etiology associated with DIC
(2) clinical bleeding
(3) organ dysfunction
(4) prothrombin time (PT)
(5) plasma fibrinogen level
(6) serum FDP levels in µg/mL
(7) platelet count
Etiologies associated with DIC:
(1) malignancy
(2) leukemia
(3) sepsis
(4) infection
(5) obstetrical complications
(6) liver disease
(7) shock
(8) idiopathic respiratory distress syndrome
(9) vascular disease
(10) collagen vascular disease
(11) hemolysis
(12) other
|
Parameter |
Finding |
Points |
|
etiology for DIC |
absent |
0 |
|
|
present |
1 |
|
clinical bleeding |
none |
0 |
|
|
present |
1 |
|
organ dysfunction |
none |
0 |
|
|
present |
1 |
|
prothrombin time |
< 15 seconds |
0 |
|
|
15 - 19.9 seconds |
1 |
|
|
>= 20 seconds |
2 |
|
plasma fibrinogen level |
> 150 mg/dL |
0 |
|
|
100.1 - 150 mg/dL |
1 |
|
|
<= 100 mg/dL |
2 |
|
serum FDP |
< 10 µg/mL |
0 |
|
|
10 - 19.9 µg/mL |
1 |
|
|
20 - 39.9 µg/mL |
2 |
|
|
>= 40 µg/mL |
3 |
|
platelet count |
> 120,000 per µL |
0 |
|
|
80,001 to 120,000 per µL |
1 |
|
|
50,001 to 80,000 per µL |
2 |
|
|
<= 50,000 per µL |
3 |
where:
• The reference range for prothrombin time, fibrinogen and FDP are not stated.
total score =
= SUM(points for all 7 parameters)
total score in leukemia =
= SUM(parameters except bleeding symptoms and platelet count)
Interpretation:
• minimum score: 0
• maximum score non-leukemia: 13
• maximum score with leukemia: 9
• The higher the score the more likely DIC is present.
• The criteria are not adapted for patients with liver disease or the nephrotic syndrome.
|
Total Score |
Diagnosis |
Confirmatory Tests |
Interpretation |
|
>= 7 |
NA |
NA |
DIC |
|
6 |
NA |
>= 2 positive |
DIC |
|
6 |
NA |
NA |
probable DIC |
|
<= 5 |
NA |
>= 2 positive |
probable DIC |
|
>= 4 |
leukemia |
NA |
DIC |
|
3 |
leukemia |
>= 2 positive |
DIC |
|
3 |
leukemia |
NA |
probable DIC |
|
<= 2 |
leukemia |
>= 2 positive |
probable DIC |
where:
• In the implementation a total score 0 was considered unlikely for DIC even if 2 or more confirmatory tests were positive.
• For non-leukemia I used a total score >= 2 as the cutoff for using confirmatory tests.
|
Confirmatory Test |
Findings |
|
antithrombin III (ATIII) level |
decreased |
|
plasma plasminogen level |
decreased |
|
protamine gelation test, cryofibrinogen, or ethanol gelation test |
positive |
|
alpha-2 antiplasmin level |
decreased |
|
plasma fibrinogen level |
50% decrease within 3 days |
|
response to heparin treatment |
improved clinical and/or laboratory findings |
|
fibrin thrombi |
present |
Specialty: Hematology Oncology, Clinical Laboratory
ICD-10: ,
