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Disseminated intravascular coagulation in children: diagnosis, management and outcome
A Chuansumrit1, S Hotrakitya, P Hathirat
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Disseminated intravascular coagulation (DIC) in 46 patients showed a high 52% fatality rate, often linked to severe underlying conditions. Effective treatments are needed to improve outcomes for this critical illness.
Area of Science:
- Pediatrics
- Hematology
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a complex acquired syndrome.
- It is characterized by widespread activation of coagulation, leading to microvascular thrombosis and organ damage.
- DIC often occurs secondary to critical illnesses and underlying conditions.
Purpose of the Study:
- To report on a retrospective study of pediatric patients with DIC.
- To analyze the clinical characteristics, laboratory findings, management strategies, and outcomes of DIC in neonates and young children.
- To identify factors associated with high case-fatality rates in this patient population.
Main Methods:
- Retrospective analysis of 46 patients diagnosed with DIC.
- Data collection included patient demographics, underlying diseases, triggering conditions, laboratory results, and treatment modalities.
- Statistical analysis was performed to identify correlations between various factors and case-fatality.
Main Results:
- The study included 23 neonates and 23 older children, with a 1:1 male to female ratio.
- Common laboratory findings included red blood cell fragmentation (93.4%), thrombocytopenia (95.5%), prolonged coagulogram (71.9%), and increased FDP (74%).
- The overall case-fatality rate was 52%, with higher mortality associated with fatal underlying diseases, shock, hemorrhage, or thrombosis.
Conclusions:
- DIC in pediatric patients, particularly neonates, is associated with a high mortality rate.
- Current management strategies, including treatment of underlying diseases and supportive care, result in a significant fatality rate.
- There is an urgent need for novel therapeutic approaches to effectively halt the progression of DIC and improve patient survival.
Abstract:
A retrospective study of 46 patients with disseminated intravascular coagulation (DIC) is reported. Twenty three patients were neonates with a mean age of 6.7 days (SD = 10) and twenty three patients had a mean age of 2.4 years (SD = 3.3). The ratio of males to females was 1:1. Thirty-two out of 46 patients (69.6%) had underlying diseases such as congenital abnormalities in cardiovascular and gastrointestinal systems. The diagnosis of DIC was suspected in the critically ill patients who had certain conditions that could trigger DIC. The laboratory findings revealed red blood cell fragmentation 93.4%, thrombocytopenia 95.5%, prolonged coagulogram 71.9% and increased FDP 74%. The management included treatment of underlying diseases, identification and relief of triggering conditions, correction of coagulopathy and supportive care. In terms of infection, appropriate antimicrobial agents were administered. Exchange transfusion was performed in 21 patients and heparin was given to patients with major vessel thrombosis such as renal vein thrombosis. Inspite of the above mentioned managements, the overall case-fatality rate was 52%. Factors related to high case-fatality rate were accompanying fatal diseases, shock, hemorrhage or thrombosis. There were no correlations between fatality rate and age, sex, triggered conditions or exchange transfusion. There is a need to establish an effective treatment that can stop the rapid ongoing process of DIC in order to achieve a better outcome in patients with DIC.