Estimation of coagulation-fibrinolytic factors in DIC.

Abstract

A computer analysis of the coagulation laboratory records at the first department of Hokkaido University Hospital over a three-year period (1979-1981) was performed on 553 patients with presumptive intravascular coagulation. It is indicated that the most important diagnostic tests for DIC were Fbg, FDP, and AT III. DIC may have developed not only in patients with reduced Fbg but also in patients with normal or elevated Fbg. It is necessary to estimate the actual situations in the patients with DIC by utilizing sequential laboratory tests. In DIC, SDS-PAGE patterns of Fbg indicated the marked reduction of LMW Fbg, and the activated fibrin formation must be caused by the high affinity of thrombin for HMW Fbg. Changes in the immunoprecipitative second peak of AT III may indicate the binding of different serine proteases to AT III in DIC. Rapid and simple diagnostic tests for DIC are clinically required. An analysis of the TEG pattern using normal plasma mixed with the patient's plasma can indicate the presence of procoagulant activity in patient plasma. Such a laboratory test using TEG is the most useful and rapid diagnostic test in DIC. An anticoagulant effect of heparin therapy is determined by APTT and heparin levels. The antithrombotic effect of heparin therapy is determined by FPA as an immediate index and by Fbg, FDP, and AT III as a slow index.