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Disseminated intravascular coagulation findings in 100 patients
A Chuansumrit1, S Hotrakitya, S Sirinavin
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Disseminated intravascular coagulation (DIC) in pediatric patients, often linked to gram-negative septicemia, presents with bleeding and low platelet counts. Effective management and positive blood cultures may improve survival rates in these critical cases.
Area of Science:
- Pediatric Hematology
- Critical Care Medicine
- Infectious Diseases
Background:
- Disseminated intravascular coagulation (DIC) is a serious condition with high mortality, particularly in pediatric patients.
- Understanding the underlying conditions and triggers for DIC in neonates, infants, children, and adolescents is crucial for effective management.
- Previous studies have highlighted the complexity of DIC management in diverse pediatric populations.
Purpose of the Study:
- To analyze the clinical characteristics, management strategies, and outcomes of pediatric patients with DIC.
- To identify factors associated with mortality in this patient cohort.
- To evaluate the impact of specific interventions and laboratory findings on DIC outcomes.
Main Methods:
- A retrospective study of 100 pediatric patients diagnosed with DIC between 1993 and 1997.
- Data collection included patient demographics, underlying conditions, triggering factors (primarily gram-negative septicemia), clinical manifestations (bleeding, thromboembolism), laboratory findings (red blood cell fragmentation, thrombocytopenia, natural anticoagulants), and management strategies.
- Statistical analysis was performed to determine factors influencing the case-fatality rate.
Main Results:
- The study included 45 neonates and 55 older pediatric patients, with 91.5% having complicated underlying conditions and all experiencing gram-negative septicemia.
- Bleeding (59.4%) and thromboembolic events (19.8%) were common. Laboratory findings included red blood cell fragmentation (89.6%) and thrombocytopenia (85.8%).
- The overall case-fatality rate was 41.6%. A significantly lower fatality rate was observed in patients with positive blood cultures (25%) compared to those with negative cultures (51.7%). Patients with febrile neutropenia responding to G-CSF also survived.
Conclusions:
- Pediatric DIC is frequently associated with severe underlying diseases and gram-negative septicemia, presenting with significant bleeding and coagulopathy.
- While overall mortality remains high, positive blood cultures and response to G-CSF in febrile neutropenic patients appear to be associated with improved survival.
- Prompt and comprehensive management, including addressing underlying diseases and supportive care, is essential, though specific factors influencing mortality require further investigation.
Abstract:
A retrospective study of 100 patients with disseminated intravascular coagulation from 1993 to 1997 is reported. Forty-five patients were neonates with a mean age of 12.6 days and 55 patients were infants, children and adolescents with a mean age of 6 years and 3 months. Most of them (91.5%) had complicated underlying conditions which included congenital anomalies, prematurity, malignancy, hematological and various diseases. Additionally, every patient had triggering conditions commonly identified as gram-negative septicemia. Bleeding and thromboembolic manifestations were found in 59.4 per cent and 19.8 per cent, respectively. The laboratory findings revealed red blood cell fragmentation, 89.6 per cent and thrombocytopenia, 85.8 per cent. Natural anticoagulants were studied in a few cases and revealed low levels of antithrombin III and protein C. The prompt effective management included treatment of underlying diseases, identification and relief of triggering conditions, correction of thrombocytopenia and coagulopathy, and fully supportive care. The overall case-fatality rate was 41.6 per cent which was not correlated with age, underlying diseases, triggering conditions, manifestation of bleeding, thromboembolism or shock, and exchange transfusion. However, a significant lower case-fatality rate was found in patients with positive culture (25%) as compared to those with sepsis and negative culture (51.7%) (p = 0.044). In addition, the febrile neutropenic patients, who showed good response to the administrated granulocyte-colony stimulating factor (G-CSF), survived from the DIC.
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