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The diagnosis of disseminated intravascular coagulation
Marcel Levi1, Evert de Jonge, Joost Meijers
1Department of Vascular Medicine and Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. m.m.levi@amc.uva.nl
Insights
Diagnosing disseminated intravascular coagulation (DIC) is challenging due to limitations in current tests. A new algorithm combining widely available tests may improve the accurate diagnosis of this complex coagulation disorder.
Area of Science:
- Hematology
- Pathophysiology
Background:
- Disseminated intravascular coagulation (DIC) involves systemic activation of coagulation with widespread fibrin deposition.
- Understanding DIC's pathogenetic pathways has advanced, yet diagnosis remains difficult.
- Current diagnostic tests often lack specificity for ongoing thrombin generation or are not widely available.
Purpose of the Study:
- To address the diagnostic challenges in disseminated intravascular coagulation (DIC).
- To evaluate the utility of a novel algorithm for diagnosing DIC.
Main Methods:
- Review of pathogenetic pathways in DIC.
- Assessment of molecular markers for coagulation activation and fibrinogen conversion.
- Evaluation of a diagnostic algorithm using widely available laboratory tests.
Main Results:
- Molecular markers, while sensitive, lack specificity for DIC diagnosis.
- Many specific diagnostic tests for DIC are not readily available in clinical settings.
- A combination of commonly available tests, integrated into an algorithm, shows promise for DIC diagnosis.
Conclusions:
- Despite advances in understanding DIC, clinical and laboratory diagnosis remains complex.
- Existing sensitive markers are often not specific enough for definitive DIC diagnosis.
- A newly developed algorithm utilizing standard tests offers a practical approach to diagnosing DIC.
Abstract:
Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation. In recent years, the pathogenetic pathways leading to DIC have been largely identified, which could result in more precise diagnostic tests for this disorder. However, the clinical and laboratory diagnosis of DIC may remain difficult, since routinely available tests do not specifically assess ongoing thrombin generation. Molecular markers for activation of coagulation and fibrinogen to fibrin conversion are highly sensitive but also disappointedly aspecific for the diagnosis of DIC. Moreover, these tests are often not available in most settings for daily clinical care. A combination of widely available tests, however, may be helpful in making the diagnosis of DIC, according to a recently developed algorithm.