Editing Disseminated intravascular coagulation (section)

==Diagnosis==
[[File:Schizocyte_smear_2009-12-22.JPG|thumb|upright=1.3|Blood film showing red blood cell fragments ([[schistocytes]])]]
The diagnosis of DIC is not made on a single laboratory value, but rather the constellation of laboratory markers and a consistent history of an illness known to cause DIC. Laboratory markers consistent with DIC include:<ref name=Levi2007/><ref name="hoffman"/><ref name="Levi19222477">{{cite journal|last=Levi|first=M|author2=Toh, C-H|title=Guidelines for the diagnosis and management of disseminated intravascular coagulation|journal=British Journal of Haematology|year=2009|volume=145|issue=5|pages=24–33|pmid=19222477|doi=10.1111/j.1365-2141.2009.07600.x|display-authors=etal|doi-access=|s2cid=694153}}</ref>
* Characteristic history (this is important because severe liver disease can essentially have the same laboratory findings as DIC)
* Prolongation of the [[prothrombin time]] (PT) and the [[activated partial thromboplastin time]] (aPTT) reflect the underlying consumption and impaired synthesis of the [[Coagulation#The coagulation cascade|coagulation cascade]].
* Fibrinogen level was initially thought to be useful in the diagnosis of DIC but because it is an acute phase reactant, it will be elevated due to the underlying inflammatory condition. Therefore, a normal (or even elevated) level can occur in over 57% of cases. A low level, however, is more consistent with the consumptive process of DIC.
* A rapidly declining platelet count
* High levels of fibrin degradation products, including [[D-dimer]], are found owing to the intense fibrinolytic activity stimulated by the presence of fibrin in the circulation.
* The [[peripheral blood smear]] may show fragmented [[red blood cell]]s (known as [[schistocytes]]) due to [[shear stress]] from [[thrombus|thrombi]]. However, this finding is neither sensitive nor specific for DIC

A diagnostic algorithm has been proposed by the International Society of Thrombosis and Haemostasis. This algorithm appears to be 91% sensitive and 97% specific for the diagnosis of overt DIC. A score of 5 or higher is compatible with DIC and it is recommended that the score is repeated daily, while a score below 5 is suggestive but not affirmative for DIC and it is recommended that it is repeated only occasionally:<ref name="Levi19222477"/><ref name="Taylor11816725">{{cite journal|last=Taylor|first=F|author2=Toh, C-h|s2cid=39696424|title=Towards Definition, Clinical and Laboratory Criteria, and a Scoring System for Disseminated Intravascular Coagulation|journal=Thrombosis and Haemostasis|year=2001|volume=86|issue=5|pages=1327–30|pmid=11816725|display-authors=etal|doi=10.1055/s-0037-1616068}}</ref> It has been recommended that a scoring system be used in the diagnosis and management of DIC in terms of improving outcome.<ref name="Gando22713612">{{cite journal|last=Gando|first=S|title=The Utility of a Diagnostic Scoring System for Disseminated Intravascular Coagulation|journal= [[Critical Care Clinics]] |year=2012|volume=28|issue=3|pages=378–88|pmid=22713612|doi=10.1016/j.ccc.2012.04.004}}</ref>
* Presence of an underlying disorder known to be associated with DIC (no=0, yes=2)
* Global coagulation results
** Platelet count (>&nbsp;100k =&nbsp;0, <&nbsp;100k =&nbsp;1, <&nbsp;50k =&nbsp;2)
** Fibrin degradation products such as D-Dimer (no increase = 0, moderate increase = 2, strong increase = 3)
** Prolonged prothrombin time (<&nbsp;3 sec = 0, >&nbsp;3 sec = 1, >&nbsp;6 sec = 2)
** Fibrinogen level (>&nbsp;1.0g/L =&nbsp;0; <&nbsp;1.0g/L = 1<ref>{{cite journal|doi=10.1111/j.1365-2141.2009.07600.x | pmid=19222477 | volume=145 | issue=1 | title=Guidelines for the diagnosis and management of disseminated intravascular coagulation | journal=British Journal of Haematology | pages=24–33| year=2009 | last1=Levi | first1=M. | last2=Toh | first2=C. H. | last3=Thachil | first3=J. | last4=Watson | first4=H. G. | doi-access= | s2cid=694153 }}</ref>)