Differentials
Severe liver failure
SIGNS / SYMPTOMS
Most common differential diagnosis and a known underlying cause of DIC.[1][2]
Absence of symptoms and signs related to thrombosis in the patients without DIC.
INVESTIGATIONS
Liver function tests: elevated; varies depending on aetiology.
international normalised ratio >1.5.
Fibrin degradation products (FDPs), D-dimer test, and platelet count may help to differentiate this from DIC.
FDPs: normal level; D-dimer test: negative.
Heparin-induced thrombocytopenia
SIGNS / SYMPTOMS
History of use of heparin in association with low platelet count, plus absence of triggering factors for DIC
INVESTIGATIONS
Heparin aggregation study: presence of platelet aggregation when exposed to heparin (caused by antibodies to platelet factor 4).
FBC: low platelet count; fibrin degradation products: normal level; D-dimer test: negative.
Idiopathic purpura fulminans
SIGNS / SYMPTOMS
Purpuric skin lesions that characteristically have well-demarcated borders.
Usually associated with sepsis and is a known underlying cause of DIC.
The idiopathic variety is often confined to the skin.
INVESTIGATIONS
Fibrin degradation products (FDPs) and D-dimer test may help to exclude DIC, but many patients will develop DIC.
FDPs: normal level; D-dimer test: negative.
Vitamin K deficiency
SIGNS / SYMPTOMS
Positive symptoms and signs of bleeding, but negative symptoms and signs of thrombosis.
Associated with a poor diet (e.g., bulimic anorexia, alcoholism) and conditions that affect gastrointestinal absorption (e.g., cystic fibrosis, inflammatory bowel disease, primary biliary cirrhosis).
INVESTIGATIONS
Vitamin K level: decreased.
International normalised ratio: elevated.
Fibrin degradation products: normal level; D-dimer test: negative.
HELLP syndrome
SIGNS / SYMPTOMS
Usually occurs after 28 weeks' gestation in pregnant women; can also occur postpartum.
Key clinical picture: severe pregnancy-induced hypertension, elevated liver enzymes, and low platelets.
Also a known underlying cause of DIC, but negative symptoms and signs of thrombosis.
INVESTIGATIONS
FBC: low platelets, anaemia may be present.
Liver function tests: elevated alanine aminotransferase and aspartate aminotransferase.
Fibrin degradation products: normal level; D-dimer test: negative (unless has progressed to DIC).
Coombs' test: positive.
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