chronic DIC

Q: All of the following can be a finding in chronic Disseminated Intravascular Coagulation (DIC) except?

A) Mild thrombocytopenia
B) Mildly prolonged PT
C) Mildly prolonged aPTT
D) Decreased plasma fibrinogen
E) Elevated plasma D-dimer


Answer: D

The teaching point for this pearl is to emphasize that in chronic DIC, fibrinogen level is unreliable.

Classic findings of DIC can be seen only in acute DIC with thrombocytopenia, prolonged PT and aPTT, low plasma fibrinogen and elevated plasma D-dimer. In chronic DIC there may be mild or no thrombocytopenia, normal or mildly prolonged PT and aPTT and elevated plasma D-dimer, but in contrast to acute DIC, plasma fibrinogen may be normal or even slightly elevated.

#hematology


Reference:

1. Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care. 2014;2(1):15. Published 2014 Feb 20. doi:10.1186/2052-0492-2-15

2. Venugopal A. Disseminated intravascular coagulation. Indian J Anaesth. 2014;58(5):603–608. doi:10.4103/0019-5049.144666