From Julia Witt:
In an effort to standardize our healthcare organizations, we are looking at our current disseminated intravascular coagulation (DIC) panel. All sites have different ideas. George, what are your suggestions?
Hi, Julia. Please forgive some self-promotion. Our handbook, Marques MB, Fritsma GA: Quick Guide to Coagulation Testing, 2nd Edition, AACC Press, 2009 provides the following recommendations for DIC:
Assays to Confirm DIC
|Platelet count||150–450,000/uL*||Normal or decreased in DIC; affected by degree of consumption and ability of bone marrow to compensate|
|PT||12.6–14.6 s*||Prolonged more often than PTT in DIC due to short half-life of factor VII|
|PTT||25–35 s*||Normal or mildly prolonged in DIC|
|Fibrinogen||220–498 mg/dL*||Reduced in severe DIC; normal or even increased fibrinogen does not exclude DIC due to increased synthesis during acute phase reaction|
|D-dimer||110–240 ng/mL*||Markedly increased in DIC (usually greater than 5,000 ng/mL)|
|*RI varies by institution, consult local laboratory manual; RI: reference interval; PT: prothrombin time, “protime”; PTT: partial thromboplastin time; DIC: disseminated intravascular coagulation|
There are also a handful of specialty assays that may provide follow-up information, particularly in chronic DIC. These include tests for soluble fibrin monomers, also called thrombus precursor protein, a sensitive test for early DIC; and the tests of fibrinolysis; plasminogen, antiplasmin, tissue plasminogen activator (TPA), and plasminogen activator inhibitor-1 (PAI-1). We don’t recommend the semiquantitative fibrin degradation products assay, which merely parallels the more sensitive and reproducible D-dimer assay. I hope this helps with your plans.