BIOMEDICAL 44 THE SCIENTIST
MY IBMS Continuing professional development
JOURNAL-BASED LEARNING EXERCISES
Please select your choice of correct answers and complete the exercises online at: www.ibms.org/cpd/jbl
DEADLINE WEDNESDAY 2 FEBRUARY 2022 Disseminated intravascular coagulation: epidemiology, biomarkers and management Adelborg K, Larsen JB, Hvas AM. Br J Haematol 2021; 192 (5): 803–18. doi: 10.1111/bjh.17172. Assessment No: 110421
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Disseminated intravascular coagulation (DIC) can be a complication of infection, malignancy, trauma or obstetrical complication. In a study of DIC patients by Siegal et al, renal dysfunction was present in a third of patients.
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In a solid tumours cancer study in the US, the prevalence of DIC in patients with ovarian and brain cancers was the same. The prevalence of DIC in patients with acute promyelocytic leukaemia (APL) is over four times the prevalence in patients with acute lymphoblastic leukaemia (ALL) in studies from the US and India.
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In a study by Okajima et al, up to half of patients with cancer-related DIC were likely to develop clinically significant bleeding.
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The ISTH scoring system for DIC differs between a basic score and if the patient is pregnant.
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Standard criteria for diagnosis of DIC has allowed comparability between studies.
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The revised Japanese Association for Acute Medicine (JAAM) score for DIC includes antithrombin as a parameter.
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The incidence of sepsis-associated DIC appeared to be falling between 2004 and 2010.
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In patients with thrombocytopenia, a marked fall in platelets may indicate hepatic cirrhosis in a differential diagnosis.
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Tissue factor may be expressed on the surface of malignant cells in cancer-related DIC.
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The thrombin generation assay does not discriminate between decreased prothrombin synthesis and increased consumption.
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Decreased von Willebrand factor (VWF) levels and increased ADAMTS13 levels contribute to increased platelet aggregation during sepsis.
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Thrombin–antithrombin (TAT) complex formation may be increased when antithrombin levels are low.
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Decreased liver synthesis and degradation by elastase contribute to lower plasma levels of protein S in sepsis.
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In the absence of bleeding, platelet concentrate may be considered if the platelet count falls below 50 x109/L.
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Cancer is often associated with a decrease in fibrinolytic activity.
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Poor clinical outcome has been associated with reduced levels of antithrombin in some studies.
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Platelet counts may be in the reference range early in DIC due to an acute-phase reaction.
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Prothrombin complex concentrates may be used in patients with major bleeding as a source of all clotting factors, plus protein C, S and antithrombin.
REFLECTIVE LEARNING 01
Discuss the use of scoring systems in the diagnosis and monitoring of DIC.
P44-45 My IBMS-JBL_November 2021_Biomedical Scientist.indd 44
02
Discuss the use of global blood tests including viscoelastic assays and thrombin generation tests in monitoring DIC.
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