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Published on: August 19, 2013
[Criteria for diagnosing DIC]
Hideo Wada1, Yasunori Abe, Junji Nishioka
1Depratment of Laboratory Medicine, Mie University School of Medicine, Mie University School of Medicine, Tsu 514-8507.
Insights
Reagent differences impact disseminated intravascular coagulation (DIC) diagnosis. PT-INR offers higher sensitivity than PT ratio, while FDP sensitivity is good but varies by reagent, necessitating standardization.
Area of Science:
- Hematology
- Clinical Chemistry
Context:
- Disseminated intravascular coagulation (DIC) is a complex hematological disorder.
- Accurate diagnostic markers are crucial for timely intervention and patient management.
Purpose:
- To evaluate the diagnostic performance of various reagents for prothrombin time (PT), fibrinogen, and fibrinogen degradation products (FDP) in patients with and without DIC.
- To compare the sensitivity and inter-reagent variability of PT ratio, PT-international normalized ratio (PT-INR), and FDP assays for DIC detection.
- To assess the concordance between the International Society of Thrombosis and Haemostasis (ISTH) overt-DIC criteria and the Japanese Ministry of Health and Welfare (JMHW) DIC criteria.
Summary:
- Significant differences in PT reagent sensitivity were observed, with PT-INR demonstrating higher sensitivity and lower inter-reagent variability for DIC detection compared to the PT ratio.
- Fibrinogen assays showed minimal differences between reagents but limited diagnostic utility for DIC.
- FDP assays exhibited good sensitivity for DIC, but marked inter-reagent variability necessitates standardization.
- The ISTH overt-DIC criteria showed approximately 70% concordance with JMHW criteria, primarily identifying typical DIC cases.
Impact:
- Standardization of PT and FDP reagents is recommended to improve diagnostic accuracy and consistency in DIC detection.
- The findings highlight the potential clinical importance of non-overt DIC diagnostic criteria in future patient management.
- PT-INR emerges as a more reliable parameter than PT ratio for DIC diagnosis due to its higher sensitivity and reagent consistency.
Abstract:
The differences between reagents of prothrombin time (PT), fibrinogen and fibrin and fibrinogen degradation products(FDP) were examined in patients with disseminated intravascular coagulation (DIC) and without DIC. The sensitivity of the PT ratio for DIC is lowered by the PT reagent with a high international sensitivity index, and the difference between PT reagents was marked. The sensitivity of PT-international normalized ratio (INR) for DIC was higher than that of the PT ratio and the difference between reagents in PT-INR was low. Though the difference between reagents for fibrinogen is slight, the usefulness in diagnosing DIC is also slight. Though the sensitivity of FDP for DIC was good, the difference between FDP reagents was marked. Therefore, standardization of PT and FDP seems to be necessary. Concordance of overt-DIC diagnostic criteria by the International Society of Thrombosis and Haemostasis (ISTH) and DIC diagnostic criteria of Japanese Ministry of Health and Welfare (JMHW) was about 70%, and overt-DIC diagnostic criteria of ISTH seemed to diagnose the typical type of DIC diagnosed by JMHW criteria. Finally, the diagnostic criteria of non-overt DIC are expected to become increasingly important.
