DIAGNOSING DISSEMINATED INTRAVASCULAR COAGULATION IN ACUTE INFECTION : CAN WE DO WITHOUT FDP & D-DIMER

Abstract

Alterations in coagulation prome viz. platelet count, prothrombin time (PT), partial thromboplastin time with kaolin (PI'TK), thrombin time (TT) and fibrinogen were studied in 96 patients (73 males and 23 females) of acute infections. Fibrinlfibrinogen degradation products (FOP) level >251-lK fibrinogen equivalent unit (FEU)/ml along-with D-dimer >1.0J.tg FEU/ml was considered criteria for diagnosis of dJsseminated intravascular coagulation (DIC). Normal values were established using plasma from 12 healthy voluntary blood donors. Out of these 96 patients, 15 had infection with Gram positive bacteria, 23 with Gram negative bacteria and 38 with Dengue. In 20 patients, nature of infection was not defined. Mean platelet count per cubic millimetre was 2.14 lac In Gram positive infection and 1.74 lac in Gram negative infection (p=O.07). There was no signiftcant dill'erence in other coagulation parameters In Gram positive and Gram negative Infection. Platelet counts were low in 71% of Dengue patients but there was no signlftcant alteration in PT, PI'TK and TT. None of the Dengue patients had hypoflbrinogenemia or DIC though hyperftbrlnogenemla was present In 21% of Dengue patients. 20 patients had features of septicemia (Gram +ve 7, Gram -ve 8, undefined 5); 10 bad concomitant DIC. DIC was present in additional 4 patients of acute infection without septicemia. P'ITK was raised in 60% of the septicemia patients. 20 out of 82 non-DIC acute infection patients had subnormal P'ITK. Commonest alteration In 14 DIC patients was raised P'ITK with a sensitivity of 78.6% and speclOclty of 81.7%. Low fibrinogen levels though spedftc for DIC, were present In only 21.4% of the DIC patients. Combinations of PI'TK >38 sec with PT >15 sec or platelet count < 1.5 Iaclmm 3 were good screening tests for DIC and detected 11 and 10 patients out of 14 with three and two false positives respectively. MJAFI 2002; 58 : 13-17