Investigations
1st investigations to order
platelet count
Test
Due to excessive consumption. Platelet count is calculated in initial evaluation and for subsequent monitoring.
Result
decreased
prothrombin time (PT)
Test
Measure of extrinsic and common coagulation pathways, prolonged in 50% to 70% of patients with DIC.
PT is measured in initial evaluation and for subsequent monitoring.
Result
often prolonged
fibrinogen
Test
Due to excessive consumption. Fibrinogen is measured in initial evaluation and for subsequent monitoring.
Result
decreased
D-dimer/fibrin degradation products
activated partial thromboplastin time (aPTT)
imaging studies or other tests
Test
Dependent on the underlying disorder and areas of thrombosis and haemorrhage.
Result
variable
Investigations to consider
thrombin time
Test
Measures the conversion of fibrinogen to fibrin.
Not required for diagnosis of DIC and should not be ordered routinely.
Result
prolonged
factor V, VIII, X, XIII
Test
Decrease due to excessive consumption.
If specific or multiple coagulation factor deficiencies are suspected, measurement of coagulation factors helps in choosing a specific replacement therapy.
Result
decreased
Emerging tests
inflammatory cytokines
Test
Inflammatory biomarkers - including interleukin (IL) 1β, IL-6, IL-8, IL-10, interferon γ, vascular endothelial growth factor, tumour necrosis factor α, monocyte chemoattractant protein-1, and epidermal growth factor - are significantly elevated in blood samples from patients with sepsis-associated DIC.[11]
Currently, no single biomarker can be used to confirm the diagnosis of DIC in patients with sepsis.
Result
elevated
D-dimer (monoclonal antibody test)
Test
Detects neoantigens produced by plasmin lysis of cross-linked fibrin. The initial D-dimer monoclonal test was based on agglutination of latex beads with monoclonal antibodies. Quantitative and automated point-of-care assays were subsequently developed as potential tools to monitor DIC.[12]
Result
elevated
antithrombin III
Test
Retrospective data suggest that patients with overt sepsis-associated DIC have significantly lower antithrombin III levels than patients with sepsis with non-overt DIC or no DIC.[13]
Result
decreased
fibrinopeptide A (FPA)
Test
A breakdown product of fibrinogen, as evidence of thrombin activity.[14]
Result
elevated
prothrombin fragment 1 and 2
Test
Evidence of factor Xa generation.[15]
Result
elevated
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