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Disseminated Intravascular Coagulopathy Case Study

  • Platelet count, PT, PTT, plasma fibrinogen, plasma d-dimer

Disseminated intravascular coagulation is suspected in patients with unexplained bleeding or venous thromboembolism, especially if a predisposing condition exists. If DIC is suspected, platelet count, PT, PTT, plasma fibrinogen level, and plasma d-dimer level (an indication of in vivo fibrin deposition and degradation) are obtained.

Slowly evolving DIC produces mild thrombocytopenia, a normal to minimally prolonged PT (results are typically reported as INR) and PTT, a normal or moderately reduced fibrinogen level, and an increased plasma d-dimer level. Because various disorders stimulate increased synthesis of fibrinogen as an acute-phase reactant, a declining fibrinogen level on 2 consecutive measurements can help make the diagnosis of DIC. Initial PTT values in slowly evolving DIC may actually be shorter than normal, probably because of the presence of activated coagulation factors in the plasma.

Severe, rapidly evolving DIC results in more severe thrombocytopenia, more prolonged PT and PTT, a rapidly declining plasma fibrinogen level, and a high plasma d-dimer level.

A factor VIII level can sometimes be helpful if severe, acute DIC must be differentiated from massive hepatic necrosis, which can cause similar abnormalities in coagulation studies. The factor VIII level is elevated in hepatic necrosis because factor VIII is made in hepatic endothelial cells and released as they are destroyed; factor VIII is reduced in DIC because of the thrombin-induced generation of activated protein C, which proteolyses the activated form of factor VIII.

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