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Lab Test: Disseminated Intravascular Coagulation Screening, DIC Level

    Lab Test
    • Disseminated intravascular coagulation screen (DIC Screen)
    Description
    • Measurement of selected blood coagulation tests for the evaluation of disseminated intravascular coagulation (DIC), including acute DIC (patients demonstrate a coagulopathy), chronic DIC (chronic microembolic processes), and for patients who are at great risk for DIC (patients with sepsis or advanced cancer).
    Reference Range
    • No evidence of DIC is normal findings
    Indications & Uses
    • Ovarian hyperstimulation syndrome - associated with abnormal coagulation studies, including a prolonged prothrombin time and a prolonged partial thromboplastin time
    • Suspected and known disseminated intravascular coagulation (DIC) - the diagnosis of DIC should be based on clinical and global coagulation tests in addition to a screening assay, when available, to assess intravascular soluble fibrin formation or fibrin degradation products (FDP). 
    • The International Society on Thrombosis and Haemostasis recommends a 5-point algorithm system for diagnosing overt DIC.  A score of greater than or equal to 5 is compatible with overt DIC, while a score of less than 5 is suggestive of , but not diagnostic for, non-overt (early) DIC.  Daily testing is recommended for a score of 5 or above, and repeat testing in 1 to 2 days is recommended for a score of less than 5.
      • Platelet count:  greater than 100,000/microL=0 points; less than 100,000/microL = 1 point; less than 50,000/microL = 2 points
      • Elevated fibrin-related marker (e.g., soluble fibrin monomers, FDP):  no increase = 0 points; moderate increase = 2 points; strong increase = 3 points
      • Prolonged prothrombin time (PT):  less than 3 seconds = 0 points; greater than 3 seconds but less than 6 seconds = 1 point; greater than 6 seconds = 2 points.
      • Fibrinogen:  greater than 1 g/L = 0 points; less than 1 g/L = 1 point.
    • Suspected and known toxic shock syndrome - DIC may develop in streptococcal toxic shock syndrome (TSS).  Isolated aPTT prolongation has also been reported, suggesting that kallikrein-kinin system activation leading to bradykinin release may occur and contribute to several key features of this syndrome.
    Clinical Application
    • This is a group of tests used to detect DIC, which many pathologic conditions can instigate or are associated with DIC.  The more common conditions include bacterial septicemia, amniotic fluid embolism, retention of a dead fetus, malignant Neoplasia, liver cirrhosis, extensive surgery (especially on the prostate or liver), extracorporeal heart bypass, extensive trauma, severe burns, and transfusion reactions.
    • In DIC, the entire clotting mechanism has been activated inappropriately, which results in significant systemic or localized intravascular formation of fibrin-based clots.  Organ injury can occur as a result of intravascular clots, which cause microvascular occlusion in various organs.
    • When a patient with a bleeding tendency is suspected of having DIC, a series of routinely performed laboratory tests are done (prothrombin time [PT], partial thromboplastin time [PTT], bleeding time, and platelet count).  If results are abnormal, further testing should be performed.
    Related Tests
    • Protein C, Protein S - this test identifies patients who are deficient in protein C and/or S.  This is part of an evaluation of hypercoagulation.
    References
    • LaGow B et al., eds. PDR Lab Advisor. A Comprehensive Point-of-Care Guide for Over 600 Lab Tests.  First ed. Montvale, NJ: Thomson PDR; 2007.
    • Pagana K, Pagana TJ eds. Mosby's Manual of Diagnostic and Laboratory Tests. 5th Ed.  St. Louis, Missouri. 2014.

MESH Terms & Keywords

  • Disseminated, Intravascular, Coagulation, Screening, DIC