Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

Abstract

Disseminated intravascular coagulation (DIC) is a serious disease that, in the presence of underlying disease, causes persistent, generalized, marked coagulation activation. Early treatment based on an appropriate diagnosis is very important for improving patients’ prognosis, to which end diagnostic criteria play a key role. Several criteria have been proposed, but each has its strengths and weaknesses, and improved criteria are needed. Widespread use of coagulofibrinolytic markers has elucidated that the pathology of DIC differs greatly as a function of the underlying disease. Thus, discriminating use of DIC diagnostic criteria that take underlying diseases into account is important.DIC diagnostic criteria that are well known in Japan include the Japanese Ministry of Health and Welfare’s old DIC diagnostic criteria (JMHW criteria), the International Society on Thrombosis and Haemostasis’s DIC diagnostic criteria (ISTH criteria), and the Japanese Association for Acute Medicine’s acute-stage DIC diagnostic criteria (JAAM criteria). Those criteria have their respective drawbacks: the sensitivity of the ISTH criteria is poor, the JAAM criteria cannot be applied to all underlying diseases, and the JMHW criteria have poor sensitivity in the case of infections, do not use molecular markers, and result in misdiagnosis. The Japanese Society on Thrombosis and Hemostasis’s newly proposed provisional draft DIC diagnostic criteria (new criteria) use diagnostic criteria classifications of “hematopoietic disorder type”, “infectious type”, and “basic type” based on the underlying pathology. For the hematopoietic disorder type the platelet count is omitted from the score, while for the infectious type, fibrinogen is omitted from the score. Also, points are added if the platelet count decreases with time. In the new criteria, molecular markers and antithrombin activity have been newly included, and as a countermeasure for misdiagnosis, 3 points are deducted if there is liver failure. In this paper, we discuss various problems encountered with DIC diagnosis, and we describe the new criteria together with the events that led to their creation.These new diagnostic criteria take into account the underlying diseases of wide area, and we expect that they will serve clinicians well due to the above adaptations and improvements.

The approval of revised diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

“…We reviewed the diagnostic criteria for DIC including the newly proposed diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis (JSTH) [2, 3]. Three diagnostic criteria for DIC have been established by the Japanese Ministry of Health and Welfare (JMHW) [4], the International Society of Thrombosis and Haemostasis [5] and the Japanese Association for Acute Medicine [6].…”

Biomarkers of disseminated intravascular coagulation in pediatric intensive care unit in Thailand

“…However, only adding AT level in ISTH DIC score showed some improvement in prediction of bleeding and mortality. Therefore, the cutoff AT level < 68% may be useful to be added in DIC score to improve the sensitivity to diagnose DIC in children which is the same recommendation by DIC subcommittee of the Japanese Society on Thrombosis and Hemostasis . However, the interpretation of natural anticoagulants in pediatric patients especially aged less than 6 months should be done cautiously as children at that ages normally have low level of natural anticoagulants due to developmental hemostasis …”

Femoral Nerve Pulsy due to Iliopsoas Muscle Hematoma: A Mini Literature Review

“…Blood tests showed WBC of 12,780/μL (3500 -9700) and CRP of 12.7 mg/dL (0 -0.3), indicating the presence of an inflammatory reaction, and Plt was decreased to 9.6 × 10 4 μL (14 -37.9), meeting the acute-phase DIC score in diagnostic criteria [3].…”