THE CRITICAL ANALYSIS ON DIAGNOSIS OF DISSEMINATED INTRAVASCULAR COAGULATION WITH SCREENING TESTS–A SCORING SYSTEM AND RELATED LITERATURE REVIEW
AbstractBackground: The aim of this study is to assess confidence in the diagnosis of DisseminatedIntravascular Coagulation (DIC); to evaluate the clinical significance of the haemostatic tests; todisclose any respective associations of such tests with patients’ prognosis; and to review therelated literature. It is a retrospective case series study in Changhua Christian Hospital, Taiwan.Methods: Ninety-four patients’ data were analyzed. A scoring system was constructedretrospectively. Results: Hypotheses were postulated and proved. Each patient had a minimalscore of 5, whereas those patients who had reached (increased) their scores were to the full or evenover the maximal level (6 or 9) respectively. There was almost no correlation between age andProthrombin Time (PT). The correlation between age and platelet count, and that between age andfibrinogen were positively minor respectively, whereas that of Activated Partial ThromboplastinTime (APTT) was +0.208. The correlations between APTT and PT, platelet count, fibrinogenrespectively were significant. About 45.67% of patients had plasma fibrinogen >200 mg/dL, while22.23% had <100 mg/dL. A paradox was observed. The finding of such a limited package of thescreening tests was discussed. Related literature with regard to the clinical significance andpitfalls, as well as limitations and strengths of these haemostatic tests were reviewed andevaluated. Conclusion: There are 14 points of impression with clinical significance outlined.Keywords: DIC, Surgical Intensive Care Unit, Laboratory diagnosis, Haemostatic test, Screening test.
Sherry, S.: Fibrionlysis, Annu al Review of Medicine, Vol.
:247, Edited by Graff, AC an d Crier, WP, Palo Alto,
Annual Reviews Inc., 1968.
Back, N. and Ambrose, JL. Fibrinolysis, Surgical Bleeding,
A Handbook for Medicine, Surge ry and Specialties, p 390,
edited by Ulin, AW and Golub, S, 1966.
Moltke, P. Plasminogen Activator in Lepto meninges, Proc.
Soc. Exp. Biol. Med. 1958;98:377.
Ratnoff, DD. Some relationships among hemos tasis,
fibrinolytic phenomence, immun ity and the inflammatory
process. Advances Immun. 1969;10:145.
Colman, RW, Girey, GJD, Zacest, R, and Talamo, RC. The
human plasmin kallikrein -kinin system, Progress in
hematology, Vol. 7, edited by Brown, EB and Moore.
Colman, RW. Activation of plas minogen by human plasma
kallikrein. Biochem. Biophys. Res. Commun., 1969;35:273.
Abildgaard, CF. Recognition an d treatment of intravascular
coagulation, J. Pediat., 1969;74:163.
Harsaway, RM. Syndromes of Disseminated Intr avascular
Coagulation, Springfield, III, Charles C Thomas, 1966.
Ingram, GIC . The defibrination syndrome, in Rec ent
Advances in Blood Coagulation, edited by Poller, L. London,
Churchill, p 263, 1969.
McGehie, WG, Rapaport, SD , and Hjort, P. Intravascular
coagulation in fulminant menin gocoiemia, Ann. Int. Med.,
McKay, DG. D isseminated Intravascular Coagulation. An
Intermediary Mechanism of Disease. New York, Hoeber, 1965.
Merskey, G, Johnson, AJ, Klein er, GJ, and Wohl, H. The
defibrination syndrome: clinic al features and laboratory
diagnosis. Brit. J. Haemat. 1967;13:528-49.
Rodriquez-Erdmann, F. Bleeding due to increased intravascular
blood coagulation: hemorrhagic syndromes caused by
consumption of blood clotting factors (consumption
coagulopathies). New Eng. J. of Med. 1965;273:1370-8.
Rosner, F, and Ritz, ND. The defrination syndrome. Archives
of Internal Medicine, 1966;117:17-24.
Verstraete, M, Vermylen, C, Ve rmylen, J , and
Vandenbroucke, J. Excessive co nsumption of blood
coagulation components as cause of hemorrhagi c diathesis,
Amer. J. Med., 1965;38:899-908.
Sicuteri, F, Fancuillacri, M, Bavazzaro, A, Franchi, G, and
Del Branco, PL. Kinins and intracranial hemorr hage,
Dalainas A. Pathogenesis, diagnosis, and m anagement of
disseminated intravascular coa gulation. Eur Rev Med
Pharmacol Sci 2008;12(1):19-31.
Kivan, HC, and McFadzcan, AJS. Plasma fibrinolytic activity
induced by ischaemia, Clin. Sci., 1956;15:245.
Taylor Jr FB, Toh C, Hoots WK, Levi M. The 21th Scientific
and standardization committee communications Towards
definition, clinical and laboratory criteria, and a scoring system
for disseminated intravascular coagulation On behalf of the
scientific subcommittee on dis seminated intravasccular
coagulation (DIC) of the international society on thrombosis
and haemostasis (ISTH), Thromb. Haemost 2001;86:1327-30.
Cate H, Bauer KA, Levi M, Edgi ngton TS, Sublett RD,
Barzegar S, Kass BL, Rosenberg RD. The activation of factor
X and prothrombin by recombina nt factor VIIa in vivo is
mediated by tissue factor. J Clin Invest. 1993;92:1207-12.
Oeth P, Parry GCN, Mackman N. Regulatio n of the tissue
factor gene in human monocytic cells. Arterloscler Thromb
Vasc Biol. 1997;17:365-74.
Muller-Berghaus G, ten Cate H, Levi M. Disseminate d
intravascular coagulation: clinical spectrum and established
as well as n ew diagnostic approaches. Thro mbosis and
J Ayub Med Coll Abbottabad 2007;19(4)
Tang, B. Disseminated Intravas cular Coagulation.
Neurotraumatology. Nov. 20, 1999, Monduzzi Editore, Italy, pp
Bone RC, Gram-positive organisms and sepsis. Arch Intern
Levi M, van der Poll T, ten Ca te H, van Deventer SJH. The
cytokine-mediated imbalance between coa gulant and
anticoagulant mechanisms in sepsis and endotoxemis, Eur J
Clin Invest. 1997;27:3-9.
Dean RT, Prydz H. Inflammatory particles stimulate
thromboplastin production by h uman monocytes. Thromb
Thap LC, Supanaranond W, Treeprasertsuk S, Kitvatanachai
S, Chinprasatsak S, Phonrat B. Septic shock second ary to
scrub typhus: characteristics and complications. Southeast
Asian J Trop Med Public Health. 2002 Dec;33(4):780-6.
Gando S, Kameue T, Nanzaki S, Nakanishi Y. Disseminated
intravascular coagulation is a frequent complication of
systemic inflammatory respons e syndrome. Thromb
Muller-Berghaus G, Madlener K, Blomback M, ten Cate JW,
eds. DIC. Pathogenesis, Diagno sis and Therapy of
Disseminated Intravascular Fib rin Formation. New York:
Elsevier Science Publishers; 1993.
Bick RL. Disseminated intravascular coagulation: a common
complication of trauma and shock. In: Borris Lc, Lassen MR,
Bergqvist D, eds. The Traumati zed Patient City: Romer
Rouman JMH, Hendriks T, van de r Ven J, Nieuwenhuijzen
GAP, Sauerwein RW, van der Mee r JWWM, Goris RJA.
Cytokine patterns in patients after major vascular surgery,
hemorrhagic shock, and severe blunt trauma. Ann Surg.
Scherer RU, Spangenberg P, Procoagulant activity in patients
with isolated head trauma. Crit Care Med. 1998;26:149-56.
Wada H, Mori Y, Okabayashi K, Gabazza EC, Kushiya F,
Watanabe M, et al. High Plasma Fibrinogen level is
associated with poor clinical outcome in DIC patients. Am J
Hematol. 2003 Jan;72(1):1-7.
Moscarella S. Ventimiglia V. T hrombotest (TT) and
Normotest (NT). Moscarella S. Ventimiglia V. Quaderni
Sclavo di Diagnost ica Clinica e di Laboratorio.
Moster ML Coagulopathies and a rterial stroke. J of Neuro -
Arocha-Pinango CL, Guerrero B. Hemorr hagic syndrome
induced by caterpillars. Clini cal and experimental studies.
Invest Clin. 2003 June;44(2):155-63.
Hirshberg A. Dugas M. Banez EI . et al. Minimizing
dilutional coagulopathy in exs anguinating hemorrhage: a
computer stimulation. Journal of Trauma-Injury Infection &
Critical Care. 2003;54(3):454-63.
Rogalski C. Paasch U. Gla nder HJ. Haustein UF. Bullous
pyoderma gangrenosum complicat ed by disseminated
intravascular coagulation with subsequent myelodysplastic
syndrome (chronic myelomonocyt ic leukemia). Journal of
Smith EY, Charles LA., Van Cot t EM. Biphasic activated
partial thromboplastin time waveform and adverse events in
non-intensive care unit patients. American Journal of Clinical
Toh CH., Giles AR et al. Waveform analysis of clotting test
optical profiles in t he diagnosis and management of
disseminated intravascular coa gulation (DIC). Clinical &
Laboratory Haematology. 2002;24(6):321-7.
Toh CH. Samis J. Downey C. et a l. Biphasic transmittance
waveform in the APTT coagulati on assay is due to the
formation of a Ca++-dependent complex of C-reactive protein
with very-low-density lipoprotein and is a n ovel marker of
impending disseminated intrava scular coagulation. Blood.
Mant MJ. Hirsh J. Pineo GF. Lu ke KH. Prolonged
prothrombin time and partial thromboplastin time in
disseminated intravascular coagulation not due to deficiency
of factors V and VIII.British Journal of Haematolog y.
Kagawa K. Fukutake K. Prothrom bin Time and its
standardization: a potentialit y to introduce INR me thod in
criteria for disseminated intr avascular coagulation].
[Japanese] Rinsho Byori Japanese Journal of Clinical
Muller-Berghaus G, ten Cate H, Levi M , Disseminated
intravascular coagulation. In: Verstraete M, Fuster V, Topol
EJ, eds. Cardlovascular Thrombosis: Thrombocardiology and
Thromboneurology, 2nd E dition. Lippincott -Raven
Publishers, New York; 1998; 781-99.
Gibney EJ, Bouchier-Hayes D. Coagulopathy and abdominal
aortic aneurysm. Eur J Vasc Surg. 1990;4:557-62.
Szlachetka DM, Kasabach-Merrit syndrome: a case review.
Neonat. Network. 1998;17:7-15.
Mitsuoka H., Unno N. Takei Y. Saito T. Ishimaru K. Miki K.
Nakamura S. Videodensitometric blood flow analysis of
abdominal aortic aneurysm and intravascular coagulation.
Journal of Vascular Surgery. 2003;38(2):340-5.
Kurukulasuriya AP. Fragmented red cells,
thrombocytopaenia and elevated D-dimers do not always
indicate the presence of disse minated intravascularr
coagulation, even in the prese nce of a bleeding tendency.
Ceylon Medical Journal. 2003;48(2):61.
Contrino J, Hair G, Kreutzer D, Rickles FR. In situ detection
of expression of tissue factor in vascular endothelial cells :
correlation with the malignant phenotype of human breast
tissue. Nature Med. 1996;209-15.
Zhang Y, Deng Y, Luther T, Muller M, Ziegler R, Waldherr
R, Stern DM, Nawroth PP. Tissue factor controls the balance
of angiogenic and antiangiogenic properties of tumor cells in
mice, J Clin Invest. 1994;94:1320-7.
Falanga A, Consonni R, Marchetti M, Locatelli G, Garattini
E, Passerini G, et al. Cancer procoagulant and tissue factor
are differently modulated by all -trans-retinoic acid in acute
promyelocytic leukemia cells Blood. 1998;92:143-51.
Ozturk M, Senqul N. Global f ibrinolytic capacity in
colorectal cancer: a new clue to occult fibrinoly sis. Clinical
& Applied Thrombosis/Haemostasis. 2003;92:151-4.
Horan JT, Francis CW. Fibrin d egradation products, fibrin
monomer and soluble fibrin in disseminated intravascular
coagulation. Seminars in Throm bosis & Haemostasis.
Bonnar J. Massive obstetric ha emorrhage. Baillieres Best
Pract Res Clin Obstet Gynaecol. 2000;14(1):1-18.
Trenk D, Althen H, Jähnchen E, Meinertz T, and S. Øie.
Factors responsible for interindividual differences in the dose
requirement of phenprocoumon. European Journal of Clinical
Tang B., McKenna P. and Rovit: Primary Fibrinolytic
Syndrome Associated with Subar achnoid Hemorrhage.
Angiology, 1973 Nov.;627-34.