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Estimation of coagulation-fibrinolytic factors in DIC
Insights
Disseminated intravascular coagulation (DIC) diagnosis relies on fibrinogen (Fbg), fibrin degradation products (FDP), and antithrombin III (AT III) tests. Rapid diagnostic methods like thromboelastography (TEG) are crucial for timely DIC management.
Area of Science:
- Hematology
- Clinical Pathology
Background:
- Disseminated intravascular coagulation (DIC) is a complex hematological disorder.
- Accurate and timely diagnosis of DIC is critical for effective patient management.
- Existing diagnostic methods require refinement for improved sensitivity and speed.
Purpose of the Study:
- To analyze coagulation laboratory records for patients with presumptive DIC.
- To identify key diagnostic markers and evaluate novel diagnostic approaches for DIC.
- To assess the effectiveness of heparin therapy in DIC patients.
Main Methods:
- Computer analysis of 553 coagulation laboratory records from 1979-1981.
- Evaluation of diagnostic tests including fibrinogen (Fbg), fibrin degradation products (FDP), and antithrombin III (AT III).
- Analysis of SDS-PAGE patterns of Fbg and immunoprecipitation of AT III.
- Assessment of thromboelastography (TEG) for detecting procoagulant activity.
- Monitoring of activated partial thromboplastin time (APTT), heparin levels, and fibrin peptide A (FPA) during heparin therapy.
Main Results:
- Fibrinogen (Fbg), fibrin degradation products (FDP), and antithrombin III (AT III) were identified as key diagnostic markers for DIC.
- DIC can occur with normal or elevated Fbg levels, necessitating sequential testing.
- SDS-PAGE revealed reduced low-molecular-weight Fbg and suggested high-affinity thrombin binding to high-molecular-weight Fbg in DIC.
- Changes in AT III immunoprecipitation patterns may indicate serine protease binding.
- Thromboelastography (TEG) demonstrated potential as a rapid diagnostic test for DIC.
- Heparin's anticoagulant effect was monitored by APTT and heparin levels; its antithrombotic effect was assessed by FPA (immediate) and Fbg, FDP, AT III (delayed).
Conclusions:
- Sequential laboratory testing is essential for accurate DIC assessment.
- Thromboelastography (TEG) offers a rapid and useful diagnostic method for DIC.
- Clinical demand exists for faster and simpler DIC diagnostic tests.
- Heparin therapy monitoring requires distinct markers for anticoagulant and antithrombotic effects.
Abstract:
A computer analysis of the coagulation laboratory records at the first department of Hokkaido University Hospital over a three-year period (1979-1981) was performed on 553 patients with presumptive intravascular coagulation. It is indicated that the most important diagnostic tests for DIC were Fbg, FDP, and AT III. DIC may have developed not only in patients with reduced Fbg but also in patients with normal or elevated Fbg. It is necessary to estimate the actual situations in the patients with DIC by utilizing sequential laboratory tests. In DIC, SDS-PAGE patterns of Fbg indicated the marked reduction of LMW Fbg, and the activated fibrin formation must be caused by the high affinity of thrombin for HMW Fbg. Changes in the immunoprecipitative second peak of AT III may indicate the binding of different serine proteases to AT III in DIC. Rapid and simple diagnostic tests for DIC are clinically required. An analysis of the TEG pattern using normal plasma mixed with the patient's plasma can indicate the presence of procoagulant activity in patient plasma. Such a laboratory test using TEG is the most useful and rapid diagnostic test in DIC. An anticoagulant effect of heparin therapy is determined by APTT and heparin levels. The antithrombotic effect of heparin therapy is determined by FPA as an immediate index and by Fbg, FDP, and AT III as a slow index.
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