Back to the future: testing in disseminated intravascular coagulation

Abstract

Following on from the first clinical observations on disseminated intravascular coagulation (DIC) in the nineteenth century, the dawn of laboratory testing for DIC began with the availability of assays that characterized the extrinsic and intrinsic pathways of coagulation. Markedly increased clotting times were the hallmark of DIC. As the understanding of the biochemistry of haemostasis and thrombosis improved, new tests were developed based on the molecular players that participate in the process. However, many are non-specific for DIC and/or are unwieldy in performance to keep apace with the demands of the acute clinical setting. The renewed emphasis in DIC for the modern laboratory of the twenty-first century has seen a return to the simple, rapid and practical global tests of coagulation within scoring systems that also capture the pathophysiological continuum by trend analysis. Additionally, new technologies based on these simple tests of coagulation hold promise in also indicating the in vivo interplay between coagulation and inflammation during DIC.

Influence of centrifuge brake on residual platelet count and routine coagulation tests in citrated plasma

“…The first important aspect that emerged from our investigation is that the residual number of PLT in the PPP was significantly higher in samples centrifuged with the brake on and, especially, the frequency of samples exhibiting a PLT count exceeding the CLSI recommended threshold of 10 PLT Â 10 9 /l was also nearly double in samples centrifuged with the brake on than in those centrifuged with the brake off (i.e. This bias should hence be considered clinically meaningful, especially for longitudinal monitoring of patient's data as in the case of disseminated intravascular coagulation [10]. This is plausibly attributable to partial resuspension of PLTs in the upper PPP because of the greater force of deceleration when the centrifuge brake is set to on.…”

“…Mean of All (s) 10 Mean (and 95% CI) bias of platelet count, activated partial thromboplastin time, prothrombin time and fibrinogen in 50 consecutive paired plasma samples obtained with the centrifuge brake set to on or off. APTT, activated partial thromboplastin time; CI, confidence interval; FBG, fibrinogen; PLT, platelet; PT, prothrombin time.…”

Diagnosis of DIC in Cats: Is It Time to Go Back to the Basics?

“…Thus, the fundamental pathogenesis of DIC consists of excessive and sustained thrombin generation, coupled with the loss of anticoagulant control mechanisms and incitement of systemic inflammation. 1,2 DIC is a dynamic evolving process. Initially, tissue factor-induced activation of coagulation produces a hypercoagulable phase, termed ''non-overt'' or ''compensated'' DIC, in which inhibitors counterbalance thrombin activity.…”

Measurement of Factor V Activity in Human Plasma Using a Microplate Coagulation Assay

“…The assay accurately measures the time, initial rate, and extent of fibrin clot formation. It requires only μl quantities of plasma, is complete in 6 min, has highthroughput, is sensitive to 24-80pM FV, and measures the amount of unintentionally activated (1-stage activity) and thrombin-activated FV (2-stage activity) to obtain a complete assessment of its total functional activity (2-stage activity -1-stage activity).Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that most often develops from pre-existing infections 14 . DIC is associated with a poor prognosis and increases mortality above the pre-existing pathology 15 .…”

“…Disseminated intravascular coagulation (DIC) is an acquired coagulopathy that most often develops from pre-existing infections 14 . DIC is associated with a poor prognosis and increases mortality above the pre-existing pathology 15 .…”