Download PDF
Thromb Haemost 1999; 82(02): 706-712
DOI: 10.1055/s-0037-1615900
Research Article
Schattauer GmbH

Disseminated Intravascular Coagulation: Clinical Spectrum and Established as well as New Diagnostic Approaches

Gert Müller-Berghaus
1   Kerckhoff-Klinik, Bad Nauheim, GERMANY
,
Hugo ten Cate
2   Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The NETHERLANDS
,
Marcel Levi
3   Center of Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Center, University of Amsterdam, The NETHERLANDS
› Author Affiliations
Further Information

Publication History

Publication Date:
09 December 2017 (online)

    Permissions and Reprints

Introduction

Although disseminated intravascular coagulation (DIC) is an “intermediary mechanism of disease”1 that has been intensively studied during the last three decades,2-4 several aspects relating to the clinical problem of DIC are still under debate. For example, a standardized definition of disseminated intravascular coagulation has not yet been agreed upon. A diagnosis can be accurately made using the facilities of a specialized laboratory, but time constraints make the diagnosis of DIC by the general laboratory difficult. Since DIC can be prevented if the right therapy is initiated early, the ability to quickly and accurately diagnose DIC and to monitor the involved dynamic processes are essential prerequisites for the effective management patients with DIC.

Due to the problems associated with defining DIC, making an early diagnosis, and effectively treating the condition following diagnosis, the clinical management of DIC can be difficult. The transition from an activated hemostatic system to a well-defined state of DIC is indistinct, and the borderlines cannot easily be distinguished. In addition, different underlying diseases mediating DIC induce different clinical symptoms associated with DIC and demand different therapeutic approaches.

 

  • References

  • 1 McKay DG. Disseminated Intravascular Coagulation. An Intermediary Mechanism of Disease. New York: Hoeber Medical Division,Harper and Row; 1964: 715-728.
    Google Scholar
  • 2 Müller-Berghaus G. Pathophysiologic and biochemical events in disseminated intravascular coagulation: Dysregulation of procoagulant and anticoagulant pathways. Sem Thromb Hemostas 1989; 15: 58-87.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Müller-Berghaus G, Madlener K, Blombäck M, ten Cate JW. eds. DIC. Pathogenesis, Diagnosis and Therapy of Disseminated Intravascular Fibrin Formation. Amsterdam: Elsevier Science Publishers B.V.; 1993
    Google Scholar
  • 4 Bick RL. Disseminated intravascular coagulation. Objective laboratory diagnostic criteria and guidelines for management. Clin Lab Med 1994; 14: 729-768.
    PubMedGoogle Scholar
  • 5 Schneider CL. Thromboplastin complications of late pregnancy. In: A Ciba Foundation Symposium. ed. Toxaemias of pregnancy. London: Churchill; 1950: 163-181.
    Google Scholar
  • 6 Ratnoff OD, Conley CL. Studies on afibrinogenemia. II. The defibrinating effect on dog blood of intravenous injection of thromboplastin material. Bull Johns Hopk Hosp 1951; 88: 414-424.
    PubMedGoogle Scholar
  • 7 Quick AJ, Hussey CV, Harris J, Peters K. Occult intravascular clotting by means of intravenous injection of thrombin. Am J Physiol 1959; 197: 791-794.
    PubMedGoogle Scholar
  • 8 Margaretten W, Zunker HO, McKay DG. Production of the generalized Shwartzman reaction in pregnant rats by intravenous infusion of thrombin. Lab Invest 1964; 13: 552-559.
    PubMedGoogle Scholar
  • 9 Müller-Berghaus G, Róka L, Lasch HG. Induction of glomerular microclot formation by fibrin monomer infusion. Thromb Diath Haemorrh 1973; 29: 375-383.
    PubMedGoogle Scholar
  • 10 Lasch HG, Krecke H-J, Rodriguez-Erdmann F, Sessner HH, Schütterle G. Verbrauchskoagulopathien (Pathogenese und Therapie). Folia haemat. (NF) 1961; 6: 325-330.
    PubMedGoogle Scholar
  • 11 Lasch H-G, Heene DL, Huth K, Sandritter W. Pathophysiology, clinical manifestations and therapy of consumption-coagulopathy (“Verbrauchskoagulopathie”). Am J Cardiol 1967; 20: 381-391.
    CrossrefPubMedGoogle Scholar
  • 12 Alkjaersig N, Fletcher AP, Sherry S. Pathogenesis of the coagulation defect developing during pathological plasma proteolytic (“fibrinolytic”) states. II. The significance, mechanism and consequences of defective fibrin polymerization. J Clin Invest 1962; 41: 917-934.
    CrossrefPubMedGoogle Scholar
  • 13 Nachman RL, Silverstein R. Hypercoagulable states. Ann Intern Med 1993; 119: 819-827.
    CrossrefPubMedGoogle Scholar
  • 14 Bauer KA. Hypercoagulable states. In: Hoffman R, Benz Jr. EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE. eds Hematology. Basic principles and practice. 2nd Ed.. New York: Churchill Livingstone; 1995: 1781-1795.
    Google Scholar
  • 15 Merlini PA, Bauer KA, Mannucci PM. Laboratory detection of the prethrombotic state. In: Verstraete M, Fuster V, Topol EJ. eds. Cardiovascular Thrombosis: Thrombocardiology and Thromboneurology. 2nd Ed.. Philadelphia: Lippincott-Raven Publishers; 1998: 103-118.
    Google Scholar
  • 16 Müller-Berghaus G, Scheefers-Borchel U, Fuhge P, Eberle R, Heimburger N. Detection of fibrin in plasma by a monoclonal antibody against the amino-terminus of the α-chain of fibrin. Scand J Clin Lab Invest 1985; 45 (Suppl. 178) 145-151.
    CrossrefPubMedGoogle Scholar
  • 17 Scheefers-Borchel U, Müller-Berghaus G, Fuhge P, Eberle R, Heimburger N. Discrimination between fibrin and fibrinogen by a monoclonal antibody against a synthetic peptide. Proc Natl Acad Sci USA 1985; 82: 7091-7095.
    CrossrefPubMedGoogle Scholar
  • 18 Bredbacka S, Blombäck M. Soluble fibrin - a predictor for development and outcome of multiple organ failure. In: Müller-Berghaus G, Madlener K, Blombäck M, ten Cate JW. eds. DIC. Pathogenesis, Diagnosis and Therapy of Disseminated Intravascular Fibrin Formation. Amsterdam: Excerpta Medica; 1993: 111-112.
    Google Scholar
  • 19 Stibbe J, Gomes M, de Oude A. The value of the FM-test (KABI) and thrombin-antithrombin-III complexes (TAT) in the management of DIC in cancer. Thromb Haemostas 1991; 65: 1238
    PubMedGoogle Scholar
  • 20 Dempfle CE, Pfitzner SA, Dollman M, Huck K, Stehle G, Heene DL. Comparison of immunological and functional assays for measurement of soluble fibrin. Thromb Haemostas 1995; 74: 673-679.
    PubMedGoogle Scholar
  • 21 Okajima K, Uchiba M, Murakami K, Okabe H, Takatsuki K. Determination of plasma soluble fibrin using a new ELISA method in patients with disseminated intravascular coagulation. Am J Hematol 1996; 51: 186-191.
    CrossrefPubMedGoogle Scholar
  • 22 Wada H, Wakita Y, Nakase T, Shimura M, Hiyoyama K, Nagaya S, Deguchi H, Mori Y, Kaneko T, Deguchi K, Fujii J, Shiku H. Increased plasma-soluble fibrin monomer levels in patients with disseminated intravascular coagulation. Am J Hematol 1996; 51: 255-260.
    CrossrefPubMedGoogle Scholar
  • 23 Pfitzner SA, Dempfle CE, Matsuda M, Heene DL. Fibrin detected in plasma of patients with disseminated intravascular coagulation by fibrin-specific antibodies consists primarily of high molecular weight factor XIIIa-crosslinked and plasmin-modified complexes partially containing fibrinopeptide A. Thromb Haemoss 1997; 78: 1069-1078.
    PubMedGoogle Scholar
  • 24 Spero JA, Lewis JH, Hasiba U. Disseminated intravascular coagulation. Findings in 346 patients. Thromb Haemost 1980; 43: 28-33.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Cembrowski GS, Griffin JH, Mosher DF. Diagnostic efficacy of six plasma proteins in evaluating consumptive coagulopathies. Use of receiver operating characteristic curves to compare antithrombin III, plasminogen α2-plasmin inhibitor, fibronectin, prothrombin, and protein C. Arch Intern Med 1986; 146: 1997-2002.
    CrossrefPubMedGoogle Scholar
  • 26 Bovill EG. Disseminated intravascular coagulation: pathophysiology and laboratory diagnosis. Fibrinolysis 1993; 7 (Suppl. 02) 17-19.
    PubMedGoogle Scholar
  • 27 Williams EC, Mosher DF. Disseminated intravascular coagulation. In: Hoffman R, Benz Jr. EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE. eds Hematology. Basic Principles and Practice. 2nd Ed.. New York: Churchill Livingstone; 1995: 1758-1769.
    Google Scholar
  • 28 Bick RL. Disseminated intravascular coagulation: objective clinical and laboratory diagnosis, treatment, and assessment of therapeutic response. Sem Thromb Hemostas 1996; 22: 69-88.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Müller-Berghaus G, ten Cate H, Levi M. Disseminated intravascular coagulation. In: Verstraete M, Fuster V, Topol E. eds Cardiovascular Thrombosis: Thrombocardiology. 2nd Ed.. Philadelphia: Lippincott-Raven; 1998: 781-799.
    Google Scholar
  • 30 Bick RL. Disseminated intravascular coagulation: pathophysiological mechanisms and manifestations. Sem Thromb Hemostas 1998; 24: 3-18.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Takahashi H, Tatewaki W, Wada K, Niwano H, Shibata A. Fibrinolysis and fibrinogenolysis in disseminated intravascular coagulation. Thromb Haemostas 1990; 63: 340-344.
    PubMedGoogle Scholar
  • 32 Fukutake K, Kuroso K, Isogai N, Shinozawa K. Clinical evaluation of D-dimer testing in disseminated intravascular coagulation (DIC). Fibrinolysis 1993; 7 (Suppl. 02) 20-22.
    PubMedGoogle Scholar
  • 33 Wada H, Wakita Y, Nakase T, Shimura M, Hiyoyama K, Nagaya S, Mori Y, Shiku H. Outcome of disseminated intravascular coagulation in relation to the score when treatment was begun. Thromb Haemost 1995; 74: 848-852.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Mesters RM, Mannucci PM, Coppola R, Keller T, Ostermann H, Kienast J. Factor VIIa and antithrombin III activity during severe sepsis and septic shock in neutropenic patients. Blood 1996; 88: 881-886.
    PubMedGoogle Scholar
  • 35 Fijnvandraat K, Derkx B, Peters M, Bijlmer R, Sturk A, Prins MH, van Deventer SJH, ten Cate JW. Coagulation activation and tissue necrosis in meningococcal septic shock: severely reduced protein C levels predict a high mortality. Thromb Haemost 1995; 73: 15-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Gando S, Kameue T, Nanzaki S, Nakanishi Y. Disseminated intravascular coagulation is a frequent complication of systemic inflammatory response syndrome. Thromb Haemost 1996; 75: 224-228.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Mesters RM, Flörke N, Ostermann H, Kienast J. Increase of plasminogen activator inhibitor levels predicts outcome of leukocytopenic patients with sepsis. Thromb Haemost 1996; 75: 902-907.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Mersky C, Johnson AJ, Kleiner GJ. The defibrination syndrome: Clinical features and laboratory diagnosis. Br J Haematol 1967; 13: 528
    CrossrefPubMedGoogle Scholar
  • 39 Lane DA, Preston FE, van Ross ME, Kakkar VV. Characterization of serum fibrinogen and fibrin fragments produced during disseminated intravascular coagulation. Br J Haematol 1978; 40: 609-615.
    CrossrefPubMedGoogle Scholar
  • 40 Nieuwenhuizen W. Degradation of fibrinogen and its derivatives in the course of disseminated intravascular coagulation. In: Müller-Berghaus G, Madlener K, Blombäck M, ten Cate JW. eds. DIC. Pathogenesis, diagnosis and therapy of disseminated intravascular fibrin formation. Amsterdam: Excerpta Medica; 1993: 117-123.
    Google Scholar
  • 41 Brower MS, Harpel PC. Alpha-1-antitrypsin-human leukocyte elastase complexes in blood: Quantification by an enzyme-linked differential antibody immunosorbent assay and comparison with α2-plasmin inhibitor-plasmin complexes. Blood 1983; 61: 842-849.
    PubMedGoogle Scholar
  • 42 Holvoet P, de Boer A, Verstreken M, Collen D. An enzyme-linked immunosorbent assay (ELISA) for the measurement of plasmin-α2-antiplasmin complex in human plasma - Application to the detection of in vivo activation of the fibrinolytic system. Thromb Haemost 1986; 56: 124-127.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 43 Williams EC. Plasma α2-antiplasmin activity. Role in the evaluation and management of fibrinolytic states and other bleeding disorders. Arch Intern Med 1989; 149: 1769-1772.
    CrossrefPubMedGoogle Scholar
  • 44 Takahashi H, Hanano M, Takizawa S, Tatewaki W, Shibata A. Plasmin-α2-plasmin inhibitor complex in plasma of patients with disseminated intravascular coagulation. Am J Hematol 1988; 28: 162-166.
    CrossrefPubMedGoogle Scholar
  • 45 van der Poll T, Levi M, Buller HR, van Deventer SJ, de Boer JP, Hack CE, ten Cate JW. Fibrinolytic response to tumor necrosis factor in healthy subjects. J Exp Med 1991; 174: 729-732.
    CrossrefPubMedGoogle Scholar