Tests for DIC.Q In my laboratory, we are suddenly getting quite a few requests for disseminated intravascular intravascular /in·tra·vas·cu·lar/ (in?trah-vas´ku-lar) within a vessel.
Within one or more blood vessels. coagulation-(DIC DIC diffuse intravascular coagulation; disseminated intravascular coagulation.
disseminated intravascular coagulation
Disseminated intravascular coagulation (DIC) ) related testing. We currently do prothrombin time (PT), partial thromboplastin time Partial Thromboplastin Time Definition
The partial thromboplastin time (PTT) test is a blood test that is done to investigate bleeding disorders and to monitor patients taking an anticlotting drug (heparin). (PTT (1) (Postal, Telegraph & Telephone) The governmental agency responsible for combined postal, telegraph and telephone services in many European countries.
(2) See push-to-talk.
PTT - Post, Telephone and Telegraph administration ), fibrinogen Fibrinogen
The major clot-forming substrate in the blood plasma of vertebrates. Though fibrinogen represents a small fraction of plasma proteins (normal human plasma has a fibrinogen content of 2–4 mg/ml of a total of 70 mg protein/ml), its conversion (FIB), D-dimer, and CBC (1) (Cell Broadcast Center) See cell broadcast.
(2) (Cipher Block Chaining) In cryptography, a mode of operation that combines the ciphertext of one block with the plaintext of the next block. . Based on my experience in a coag lab a few years ago, I am suggesting fibrin monomer as additional testing. Would this be helpful, or is our current testing adequate?
A The Scientific Subcommittee (SSC) on Disseminated Intravascular Coagulation disseminated intravascular coagulation
Abbr. DIC A hemorrhagic disorder that occurs following the uncontrolled activation of clotting factors and fibrinolytic enzymes throughout small blood vessels, resulting in tissue necrosis and of the International Society on Thrombosis and Haemostasis hemostasis, haemostasis
the stoppage of bleeding or cessation of the circulation of the blood; stagnation of the blood in a part of the body. Also hemostasia, haemostasia.
See also: Blood and Blood Vessels
Noun 1. (ISTH ISTH International Society on Thrombosis and Haemostasis (Carrboro, North Carolina)
ISTH Interamerican Society for Tropical Horticulture ) published a definition of DIC as well as clinical and laboratory criteria for diagnosis in the December 2001 issue of Thrombosis and Haemostasis. In this publication, the Subcommittee distinguished overt DIC from non-overt DIC. The Subcommittee defined overt DIC as that which occurs in a decompensated hemostatic system and non-overt as a compensated phase in which there is subtle hemostatic dysfunction.
In an effort to standardize diagnosis and determination of the severity of DIC, the ISTH Subcommittee on DIC has developed a five-step diagnostic algorithm that can be used to calculate a DIC score. A five-year overview of this scoring system was published on behalf of the SSC on DIC of the ISTH in the March 2007 issue of Thrombosis and Haemostasis and concluded that a score of five or greater can identify overt DIC. The diagnostic algorithm for the diagnosis of overt DIC is provided in Table 1.
In this report, it was stressed that assays used in the diagnosis of overt DIC should be readily available laboratory tests. According to the ISTH Subcommittee on DIC, major laboratory criteria for the diagnosis of overt DIC include platelet count, prothrombin time, fibrinogen level, and a marker of the presence of fibrin, which can be ascertained by one of the following assays: soluble fibrin monomer, fibrin degradation products, and/or D-dimer. In the 2003 meeting of the SCC SCC - strongly connected component on DIC, D-dimer was proposed as the ideal fibrin marker.
Therefore, the following battery of assays, PT/FIB/D-dimer/CBC, should be adequate in the evaluation of overt DIC, without the inclusion of a fibrin monomer assay. This is advantageous, as there is currently no manufactured kit available in the United States for the quantitation of soluble fibrin monomer. Diagnostica Stago offers a rapid qualitative slide test for soluble fibrin monomer complexes in plasma by the hemagglutination hemagglutination /he·mag·glu·ti·na·tion/ (he?mah-gloo-ti-na´shun) agglutination of erythrocytes.
n. technique (F.S. Test). (1) This assay, however, is not as sensitive to the presence of fibrin monomers in plasma as a quantitative immunologic-based soluble fibrin monomer assay.
--Dorothy M. Adcock, MD
1. F.S. Test [package inser]. Parsippany, NJ: Diagnostica Stago; October 2003.
2. Toh CH, Hoots WK. The scoring system of the Scientific and Standardization Committee on Disseminated Intravascular Coagulation of the International Society on thrombosis and haemostasis: a 5-year overview. J Thromb Haemost. 2007;5:604-606.
3. Taylor FB, Toh CH, Hoots WK, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327-1330.
4. Minutes from the Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis. July 2003, Birmingham, U.K. Hoots WK, Chairman.
Table 1. Diagnostic algorithm for the diagnosis of overt DIC (2-4) Risk assessment: Does the patient have an underlying disorder known to be associated with over DIC? If yes, proceed; if no, do not use this algorithm; Order global coagulation tests Score global coagulation results platelet count (>100 = 0; <100 = 1; <50 = 2) elevated fibrin-related marker (e.g., D-dimer, soluble fibrin monomers/ fibrin degradation products) (no increase: 0; moderate increase: 2; strong increase: 3) prolonged prothrombin time (<3 sec. = 0; >3 sec. but <6 sec. = 1; >6 sec. = 2) fibrinogen level (>1.0 gram/l = 0; <1.0 gram/l = 1) Calculate score If [greater than or equal to] 5: compatible with overt DIC; repeat scoring daily if <5: suggestive (not affirmative) for non-overt DIC; repeat next one to two days.