Review
Disseminated intravascular coagulation

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Abstract

The diagnosis of disseminated intravascular coagulation (DIC) was initially based on the detection of microthrombi. Current diagnosis involves laboratory assessment of hemostatic abnormalities although additional studies may often be necessary. DIC is characterized by hypercoagulability and hyperfibrinolysis and is caused by high offense factors or low defense factors. DIC is divided two stages: overt-DIC and non-overt-DIC. The diagnosis of overt-DIC state is based on the criteria developed by the International Society of Thrombosis Haemostasis in conjunction with the Japanese Ministry Health and Welfare. However, no criteria are currently available for the diagnosis of non-overt DIC. Although scientifically supported modalities for treatment of DIC are few, the use of activated protein C (APC) and low-molecular-weight heparin appear to hold promise.

Section snippets

History

The underlying condition in the first report of disseminated intravascular coagulation (DIC) was gynecological disease, which was followed by the report of several cases of DIC associated with leukemias and solid cancers. The concept of DIC was established from these reports. The detection of microthrombi in patients with DIC called for the use of heparin in patients with bleeding. Treatment of hemorrhage due to consumption coagulopathy was the primary goal of therapy. Although several groups

Pathophysiology

Based on the 1997 survey study of DIC by JMHW, the frequency of DIC per hospitalized patient was 1.72% in Japan. Underlying diseases frequently associated with DIC in these patients were acute promyelocytic leukemia (APL), fulminant hepatitis and sepsis. As can be seen, most patients with DIC had sepsis, non-Hodgkins lymphoma or hepatoma (Table 2). While DIC is a condition characterized by overactivation of both the coagulation and fibrinolysis systems in the systemic microvasculature, it was

Definition and concept

Although various definitions have been advocated for DIC by many researchers, these definitions typically never agree with each other [8]. The JMHW has defined the diagnostic criteria of DIC and its definition is widely used in Asian countries. However, the JMHW has not provided a satisfactory definition of DIC because these standards were initially designed to simplify the diagnosis of typical DIC [8]. Although detection of microthrombi was initially considered as necessary for the definition

Treatments

In leukemia and lymphoma, advances in adjuvant therapies such as antibiotics, granulocyte-colony stimulating factor (G-CSF), and blood transfusion, coupled with administration of all-trans-retinoic acid (ATRA) for APL, have decreased the frequency and mortality of DIC. However, the frequency and mortality of DIC are still high in ICU patients, especially those with sepsis.

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      The fibrinogen/CRP ratio was <104 in the bleeding group. In previous studies, the sensitivity of hypofibrinogenemia to predict DIC was reported as only 28% (Levi, 2007; Wada, 2004), but the fibrinogen/CRP ratio further enhanced the diagnostic power of DIC (Taylor et al., 2001). In this study, we showed that thrombocytopenia (<100,000 platelets/mm3) and a low fibrinogen/CRP ratio (<104) were hemostasis-related factors that were independently associated with clinical bleeding.

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