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Experience with disseminated intravascular coagulation in a children's hospital
Insights
Disseminated intravascular coagulation (DIC) is frequent in infants, often linked to gram-negative sepsis. Management strategies showed disappointing results, highlighting the need for improved pediatric DIC treatments.
Area of Science:
- Pediatric Hematology
- Critical Care Medicine
- Infectious Diseases
Background:
- Disseminated intravascular coagulation (DIC) is a serious condition with high mortality.
- Understanding the incidence and characteristics of pediatric DIC is crucial for effective management.
Purpose of the Study:
- To determine the frequency and clinical significance of DIC in pediatric patients.
- To identify associated conditions and laboratory findings in pediatric DIC cases.
Main Methods:
- A scoring system was used to diagnose DIC in pediatric patients.
- Data were collected over one year at a pediatric referral center with 7000 annual admissions.
Main Results:
- DIC was diagnosed in 48 pediatric patients.
- 60% of DIC cases occurred in infants under one month.
- Sepsis, particularly gram-negative, was associated with 66% of DIC cases; 79% of affected neonates were septic.
- Key laboratory findings included anemia with red cell fragmentation, thrombocytopenia, elevated fibrin split products, abnormal thrombin time, and low factor V activity.
- Overall mortality was 64% across all age groups.
Conclusions:
- Pediatric DIC, especially in neonates, is frequently associated with sepsis.
- Current management approaches, including treating underlying diseases with or without anticoagulation, yielded disappointing outcomes.
- Further research is needed to improve therapeutic strategies for pediatric DIC.
Abstract:
A study was initiated to determine the frequency and significance of disseminated intravascular coagulation (DIC) in the pediatric age group. With the aid of a scoring system, DIC was diagnosed in 48 patients in a period of slightly over one year in a pediatric referral centre with 7000 annual admissions. Sixty percent of all DIC occurred in infants under one month of life. Sixty-six percent of all DIC was associated with sepsis, usually from gram-negative infections. Seventy-nine percent of affected neonates were septic. Laboratory findings of diagnostic importance were anemia with red cell fragmentation, thrombocytopenia, elevated titres of fibrin split products, abnormal thrombin time, and low factor V activity. Mortality was 64% in all ages regardless of cause. Results of management of DIC by treatment of the underlying disease with or without anticoagulation were disappointing.