Back to the future: testing in disseminated intravascular coagulation

Area of Science:

• Hematology
• Clinical Pathology
• Coagulation Science

Background:

• Disseminated intravascular coagulation (DIC) has been observed clinically since the 19th century.
• Early laboratory diagnostics for DIC focused on coagulation pathway assays, with prolonged clotting times as a key indicator.
• Advancements in understanding hemostasis and thrombosis led to molecularly-based assays, but many lack specificity or practicality for acute settings.

Purpose of the Study:

• To review the evolution of laboratory testing for disseminated intravascular coagulation (DIC).
• To highlight the shift towards practical, rapid global coagulation tests in modern DIC diagnostics.
• To discuss the potential of new technologies in assessing the interplay between coagulation and inflammation in DIC.

Main Methods:

• Historical review of laboratory diagnostic methods for DIC.
• Analysis of the transition from pathway-specific assays to global coagulation tests.
• Exploration of emerging technologies for DIC assessment.

Main Results:

• Early DIC tests were often non-specific or too slow for clinical use.
• Current trends favor simple, rapid global coagulation tests integrated into scoring systems.
• Trend analysis of global tests aids in understanding the pathophysiological continuum of DIC.
• New technologies show promise in evaluating in vivo coagulation-inflammation interactions in DIC.

Conclusions:

• Modern laboratory diagnostics for DIC are returning to practical, rapid global tests.
• Scoring systems and trend analysis enhance the clinical utility of these tests.
• Future technologies may offer deeper insights into the complex pathophysiology of DIC.