Diagnosis of disseminated intravascular coagulation. Role of D-dimer

Detection of the cross-linked fibrin degradation fragment, D-dimer, in patients at risk for disseminated intravascular coagulation (DIC) is strong evidence for the diagnosis. D-dimer confirms that both thrombin generation and plasmin generation have occurred. Patients at risk for DIC (58) and normal controls (7) were studied. Thirty-three patients had DIC--with fragment D-dimer identified in their serum by immunoblotting. Latex agglutination measurements of fibrin(ogen) degradation products (FDPs) and D-dimer were compared with immunoblotting in the detection of D-dimer. FDP measurement was extremely sensitive but not specific. D-dimer measurement was less sensitive but highly specific. Used in tandem, screening with FDP and confirming with D-dimer, sensitivity and specificity were maximized, rendering a predictive value of a confirmed FDP of 100% in this cohort. D-dimer is a valuable adjunct for the laboratory diagnosis of DIC but is most appropriately used as a confirmatory test for the very sensitive FDP test.     

弥散性血管内凝血的放射自显影研究

大白鼠注射~(125)I标记的纤维蛋白原后,再注射凝血酶,造成弥散性血管内凝血。放射自显影检查发现,同位素标记的微血栓主要位于肾小球毛细血管,直小血管之中。肺泡的毛细血管也可发现这些微血栓。肝脏和脾脏的网状内皮细胞吞噬了大量的标记物质,这些吞噬细胞定位在肝门区,而在脾脏则位于马氏小体周围。此外,在肾小管的上皮细胞内也发现有同位素,这些物质可能是通过肾小球过滤而被肾小管重吸收的标记物质。用自显影术,常规染色和纤维蛋白的特殊染色互相比较,肺的微血栓在常规和特殊染色中不能被发现,用自显影术则很易检出同位素标记的微血栓。     

Histopathological evaluation of disseminated intravascular coagulation in Haemophilus somnus infection in cattle

The frequency and distribution of fibrin thrombi (microthrombi) in the main organs of spontaneously infected cattle were investigated to evaluate disseminated intravascular coagulation (DIC) in Haemophilus somnus infection. This infection is well known as infectious thrombo-embolic meningo-encephalitis (ITEME) and is characterized histopathologically by formation of thrombi, necrosis of blood vessels and neutrophil infiltration. The precise pathogenic mechanism of this disease has not yet been fully elucidated. The liver, spleen, kidney, lung, heart and brain of 11 cattle showing thromboembolic meningo-encephalitis were examined histopathologically and special attention was paid to fibrin thrombi. PTAH staining showed a high frequency of fibrin thrombi in the small vessels and capillaries in more than 3 organs and all the cases were regarded as falling within the histopathological criterion of DIC. The results of the present study indicate that the pathogenesis of the infection is closely related to the DIC.     

Distribution patterns of microthrombi in disseminated intravascular coagulation

Distribution of microthrombi in 37 autopsy cases of untreated disseminated intravascular coagulation (DIC) was studied histologically. According to the organs predominantly involved, four patterns of distribution were distinguished: hepatic, hepatorenal, renal, and undetermined. The results suggested that these patterns indicated the course of DIC and the function of Kupffer's cells in the liver, whose role in the course of DIC was evaluated.     

Trombocytopenia: one of the markers of disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) is a complication of a variety of severe underlying diseases and a contributing factor in multi-organ failure and death. DIC is diagnosed on the basis of clinical findings (organ failure, bleeding) and laboratory abnormalities. The laboratory data include (repeated) measurements of platelet count and global clotting tests, to which more specific and sensitive tests for activated coagulation are added. The focus of this paper is on thrombocytopenia (platelet count < 100 x 103/microl) as a marker in DIC. First, in patients with suspected DIC it is imperative to consider alternative causes of thrombocytopenia,such as related to heparin use (heparin induced thrombocytopenia II) or thrombocytopenic purpura. Second, the observation of thrombocytopenia in relation to DIC should be interpreted as a marker of advanced or overt DIC and not as an early indicator.According to recommended guidelines measurements of platelet counts should always be coupled to a panel of coagulation markers and not be used as single marker of DIC (or other syndromes). In general, thrombocytopenia should not trigger platelet transfusions except in patients with severe bleeding complications.     

One-stage method for assay of tissue factor activity of leukemic cell with special reference to disseminated intravascular coagulation

Tissue factor activity (TFA) of leukemic cells (1 x 10(8) cells/mL) was measured in 44 patients with acute nonlymphoid leukemia (ANLL) by the one-stage assay using factor-IX deficient plasma (OSA-dIX) and two-stage assay (TSA). According to the preventative heparin dose schedule based on the TFA measured by the TSA, all disseminated intravascular coagulation (DIC) was controlled successfully. The procedure of the TSA was too complicated for clinical use, and its minimal measurable value was 125 units (U)/L of TFA. The OSA-dIX was simpler in its procedure and sensitive enough to measure accurately a TFA quantity as small as 30 U/L with high reproducibility. In 20 ANLL patients with 125 U/L or more of TFA measured by both assays, there was a significant relationship between their logarithms of TFA (r = 0.93, P less than 0.01). These results suggested that DIC complication in ANLL patients would be controlled successfully by the administration of heparin dosage based on the TFA measured by the OSA-dIX.     

Importance of immunoenzyme histochemical reaction in diagnosis of disseminated intravascular coagulation in human and animal material

Renal tissues from 208 human necropsies were observed histologically for disseminated intravascular coagulation (DIC). The tissues were stained with hematoxylin-eosin, Mallory's phosphotungstic acid hematoxylin (PTAH) and cationic ferric hydroxide colloid stabilized with cacodylate (Fe-Cac), and tested by immunoenzyme histochemical (IEH) reaction for fibrin-related materials (FRMs). The use of the IEH method increased FRM recognition, and FRMs were detected in a total of 80 cases (38.5%). In 26 cases diagnosed clinically as DIC, FRMs were shown in 23 of the cases (88.5%). Thus, 57 patients with FRMs were clinically asymptomatic. In rats with DIC induced by endotoxin injection, glomerulus FRM was effluxed into the tubulus through the Bowman's capsule and was excreted into urine. The electric charge was reduced on the endothelial surface of the glomerular capillaries in both human and rat DIC. Under the scanning electron microscopy, the endothelial surface appeared coarse in the glomerular capillary and fibrin degradation was present. Our conclusions are: (a) PTAH is non-specific for FRMs, (b) IEH aids the pathohistological diagnosis of DIC, especially in asymptomatic forms including the compensated DIC state, (c) FRMs in tubuli suggest DIC, and (d) DIC is possibly initiated by a reduction in the capillary electric surface charge.     

Fatal Salmonella septicaemia with disseminated intravascular coagulation and renal failure

Four elderly patients with salmonella septicaemia complicated by irreversible endotoxic shock and acute renal failure are described. The organism isolated from three of the patients with Salmonella typhimurium, which is not usually invasive; the fourth patient was infected with S. abony. The factors associated with the severe systemic infections are discussed. Clinical and haematological findings suggested disseminated intravascular coagulation, and this was subsequently confirmed histologically in each patient by the identification of haematoxylinophil bodies in the pulmonary and renal microcirculations.     

D-dimer test after standardized coagulation: A new assay for global evaluation of the unstimulated fibrinolytic system

In spite of recently developed analyses for specific components of the fibrinolytic system, a need for global tests still exists. Presently, most global testing is performed either after unpleasent stimulation of the fibrinolytic system, or with time-consuming and imprecise tests.In the present study we have evaluated a D-dimer test (ELISA method) in serum after standardized coagulation in unstimulated individuals, and related the results to those of t-PA and PAI-I activities.28 healthy individuals, 49 patients with coronary heart disease (CHD) and 12 hypertriglyceridemic individuals were tested in the fasting state between 08:00 and 10:00.In the healthy individuals an arbitrary lower reference value of 0.34 ug/ml was established, whereas the median value was 0.86 ug/ml. In the CHD and hypertriglyceridemic groups, the median values were 0.41 ug/ml and 0.18ug/ml, respectively. When the individuals were grouped according to their values to t-PA and PAI-I activities, it emerged that the D-dimer in serum was influenced mainly by PAI-I, but that high values of t-PA determined the global test in some individuals.A good correlation was found between the D-dimer test and both the t-PA (r=0.63) and PAI-I (r=-0.71) activities. We conclude that the presently used D-dimer test in serum is suitable for global testing of the fibrinolytic system. Its clinical relevance has to be evaluated in clinical trials.     

Method for determining the age of the fibrin in the disseminated intravascular coagulation syndrome

Three methods for the detection of generalized intravascular coagulation are proposed. The dyes produced in the USSR are used in these methods: acid red 2C--orange-red-blue method; acid yellow light-proof--picric red-blue method; acid blue-black in the method called red-blue-black. The use of these methods allows one to determine the duration of the fibrin existence in the vessels and to distinguish "young", "mature" and "old" fibrin.