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[Coagulation and fibrinolysis parameters in disseminated intravascular coagulation (DIC)]
T Nakagawa1, H Saito, Y Watanabe
1Department of Laboratory Medicine, Niigata Cancer Center Hospital.
Insights
Disseminated intravascular coagulation (DIC) involves hypercoagulability and accelerated fibrinolysis, indicated by elevated thrombin/antithrombin III complex (TAT) and plasmin/alpha 2 plasmin inhibitor complex (PIC) levels. These markers are crucial for diagnosing DIC, even with normal fibrinogen and platelet counts.
Area of Science:
- Hematology
- Clinical Chemistry
- Pathophysiology
Context:
- Disseminated intravascular coagulation (DIC) is a complex syndrome characterized by systemic activation of coagulation and fibrinolysis.
- Accurate and timely diagnosis of DIC is critical for patient management and outcomes.
- Traditional diagnostic markers may not always reflect the dynamic nature of DIC.
Purpose:
- To evaluate the utility of specific coagulation and fibrinolysis markers in diagnosing different stages of suspected disseminated intravascular coagulation (DIC).
- To assess the prevalence of elevated thrombin/antithrombin III complex (TAT), plasmin/alpha 2 plasmin inhibitor complex (PIC), D-dimer (D-D), and fibrin monomer (FM) in patients with suspected DIC.
- To explore the relationship between these markers and the clinical classification of DIC.
Summary:
- Eighty-six plasma samples from 41 patients with suspected DIC were analyzed across three groups: established (A), possible (B), and probable (C) DIC.
- Significantly elevated TAT and PIC levels were observed in established DIC, indicating hypercoagulability and accelerated fibrinolysis.
- Abnormal TAT, PIC, and D-D were prevalent (86-100%) across all groups, with FM present in a majority of samples, suggesting widespread activation of coagulation and fibrinolysis even when fibrinogen and platelet counts were normal.
Impact:
- The findings highlight the sensitivity of TAT, PIC, and D-D in detecting DIC-related hemostatic abnormalities.
- These markers can aid in diagnosing DIC, particularly in early or less severe cases where conventional parameters may be normal.
- Understanding the role of these markers contributes to a better grasp of DIC pathophysiology and clinical diversity.
Abstract:
Eighty six plasma samples from 41 patients with suspected disseminated intravascular coagulation (DIC) were divided into 3 groups as follows: Group A, 53 samples from established DIC; Group B, 19 samples from possible DIC; and Group C, 14 samples from probable DIC. The following parameters of coagulation and fibrinolysis were evaluated: thrombin/antithrombin III complex (TAT), plasmin/alpha 2 plasmin inhibitor complex (PIC), D-dimer (D-D) and fibrin monomer (FM). In Group A, TAT and PIC were significantly elevated, being 29.5 +/- 20.7 micrograms/l and 7.2 +/- 6.1 mg/l respectively, suggesting marked hypercoagulability and accelerated fibrinolysis. There were no correlations between antithrombin III (ATIII) and TAT, between alpha 2 plasmin inhibitor (alpha 2PI) and PIC, or between TAT and PIC, showing the clinical diversity of patients with DIC. In all groups abnormal TAT, PIC and D-D findings were observed in many samples (86-100%), and FM was present in 83%, 63%, and 29% of samples in Groups A, B, and C respectively. In Groups B and C, abnormal findings for TAT, PIC, D-D, FM and alpha 2PI apparently indicated hypercoagulability and accelerated fibrinolysis, even though fibrinogen and platelet count were within normal limits.