Diagnosis and treatment of disseminated intravascular coagulation

Abstract

Disseminated intravascular coagulation (DIC) is an etiology of microangiopathic hemolytic anemia characterized by microthrombus formation due to persistent coagulation activation in the presence of specific underlying diseases. If therapeutic interventions are not promptly implemented, consumptive reduction of coagulation/fibrinolysis (C/F)-related factors and thrombocytopenia can be fatal. The degree of fibrinolysis varies with the underlying disease. For instance, in acute promyelocytic leukemia, the degree of fibrinolysis exceeds coagulation, leading to bleeding symptoms (enhanced-fibrinolysis DIC), whereas in sepsis, the suppression of fibrinolysis results in a procoagulant state, causing frequent microthromboses and organ damage (suppressed-fibrinolysis DIC). In clinical practice, accurate assessment of the balance between C/F potential is challenging, which is compounded by the existence of varying diagnostic criteria for DIC. The Japanese Ministry Health and Welfare DIC scoring system, which has been most employed in Japan, has adequate specificity while exhibiting insufficient sensitivity for the early diagnosis of DIC. The Japanese Association for Acute Medicine’s acute-stage DIC diagnostic criteria are the next most used. The International Society on Thrombosis and Haemostasis’s DIC diagnostic criteria also exhibit issues with early diagnosis. The Japanese Society on Thrombosis and Hemostasis published the diagnostic criteria for DIC in its 2017 edition. The Guideline of Diagnosis and Clinical Management for Neonatal DIC 2016 has been implemented for neonates. Although the primary focus is on treating the underlying disease, an awareness of the balance between C/F potential is crucial in DIC treatment, as a precise understanding of this balance can lead to effective treatment.