Diagnosis of DIC

• Clinical setting
• Laboratory tests
• Criteria
• Underlying disease known to be associated
• Initial platelet count < 100 X 109/L, or rapid decline in
platelet count
• Prolongation of clotting times (PT & APTT)
• Presence of fibrin degradation products
• Low levels of coagulation inhibitors (e.g. antithrombin)
• Low fibrinogen level in severe cases

Bachelor of Chinese Medicine

Disseminated intravascular coagulation

• Laboratory results:
• Prolonged PT, APTT and TT
• Reduced fibrinogen level
• Increased D-Dimers
• Thrombocytopenia
• Microangiopathic changes in blood film

Bachelor of Chinese Medicine

Laboratory Diagnosis

Analysis Early changes Late changes

Platelets / 
APTT  
Fibrinogen  
D-dimer  
F:II,VII,X  
Protein C  
Anti-thrombin  
TAT complex  
Soluble fibrin  
Diagnostic Algorithm for Overt DIC

Risk assessment: Does the patient have an underlying disorder known to be

associated with overt DIC? If yes: proceed; If no: do not use this algorithm.
Order global coagulation tests (platelet count, PT, fibrinogen, soluble fibrin
monomers or fibrin degradation products)
Score global coagulation test results
Calculate score
Scoring System For DIC

Risk assessment: YES NO

Underlying disorder known to be associated with DIC Continue Stop
Global coagulation
tests

Platelet count
(> 100 = 0, < 100 = 1, < 50 = 2)

Soluble fibrin/D-dimer
(no increase = 0), ↑ moderate increase: =2, ↑ ↑ strong
increase = 3
Prolongation of PT
(<3 sec = 0; >3 -6 sec =1; >6 sec = 2)
Fibrinogen level
(> 1.0 g/l = 0; < 1.0 g/l = 1)
Calculate score
Calculated Score
Patient scores is >5: compatible with overt DIC, (decompensated
hemostasis) repeat scoring daily
Patient scores is <5: suggestive (not affirmative) for non-overt DIC,
repeat next 1-2 days
Taylor, Thromb Haemostas 2001;86:1327-1330
 Algorithm for Diagnostic Sequence for Determining Non-
overt DICK Non-overt DIC

1. Risk assessment:
Does the patient have an underlying disorder known to be associated with DIC? If yes:
proceed
2. General criteria
Platelet count >100 x 109/L = <100 x 109/L Rising = -1 Stable = Falling = Score
0 =1 0 1
PT prolongation <3s >3s Falling = -1 Stable = Rising = 1
0
Soluble fibrin or Normal Raised Falling = -1 Stable = Rising = 1
FDPs 0
3. Specific criteria
Antithrombin Normal = - Low = 1
1
Protein C Normal = - Low = 1
1
TAT complexes Normal = - High = 1
1
4. Calculate score