Background
Differences in the definition and concept of DIC and TMA
Differences and similarities in the mechanism of onset for DIC and TMA
Difference in the diagnosis between DIC and TMA
ISTH | P | JSTH | P | JMHLW | P | JAAM | P | |
---|---|---|---|---|---|---|---|---|
PLT (× 103/μl) | 100 ≧ > 50 | 1 | 120 ≧ > 80 | 1 | 120 ≧ > 80 | 1 | 120 ≧ > 8.0 | 1 |
50 ≧ | 2 | 80 ≧ > 50 | 2 | 80 ≧ > 50 | 2 | |||
50 ≧ | 3 | 50 ≧ | 3 | 80 ≧ | 3 | |||
Reduction of PLT | 30% | 1* | 30% | 1* | ||||
50% | 3* | |||||||
Prothrombin time ratio or Prolongation (s) | 3 ≦ < 6.0 | 1 | 1.25 ≦ < 1.67 | 1 | 1.25 ≦ < 1.67 | 1 | 1.2 ≦ | 1 |
6 ≦ | 2 | 1.67 ≦ | 2 | 1.67 ≦ | 2 | |||
Fibrinogen (g/L) | 1.0 ≧ | 1 | 1.5 ≧ > 1.0 | 1 | ||||
1.0 ≧ | 2 | |||||||
Fibrin related markers, FDP (μg/ml) | 10 ≦ < 20 | 1 | 10 ≦ < 20 | 1 | 10 ≦ < 25 | 1 | ||
Increase | 2 | 20 ≦ < 40 | 2 | 20 ≦ < 40 | 2 | |||
Markedly increase | 3 | 40 ≦ | 3 | 40 ≦ | 3 | 25 ≦ | 3 | |
Antithrombin | < 70% | 1 | ||||||
TAT or SF | 2 fold higher of NR | |||||||
Underlying diseases | Positive | 1 | ||||||
Bleeding | Positive | 1 | ||||||
OF due to thrombosis | Positive | 1 | ||||||
SIRS | Positive | 1 | ||||||
DIC | 5 ≦ | 5 ≦ | 7 ≦ | 4 ≦ |
STEC-HUS | aHUS | TTP | TMA | |
---|---|---|---|---|
Hemoglobin (g/dl) | 10.0 ≧ | 10.0 ≧ | Hemolysis | 10.0 ≧ |
Platelet (× 104/μl) | 15.0 ≧ | 15.0 ≧ | Thrombocytopenia | 15.0 ≧ |
Ogan failure | Renal failure Creatinine ≧1.5 folds of the standard | Renal failure Creatinine ≧1.5 folds of the standard | Neurological symptoms | ? |
Laboratory finding | Detection of STEC | Genetic abnormality in the complement system | ADAMTS13 < 10% | ? |
Differences and similarities between DIC and TMA
Severe DIC | Severe TMA | ||
---|---|---|---|
Symptoms | Organ failure | Often (Lung, Kidney, Shock) | Usually (Kidney, CNS) |
Bleeding and bleeding tendency | Frequent | Frequent | |
Blood pressure | Low | High | |
Hematuria | Sometimes | Frequent | |
Anemia | Often | Usually | |
Laboratory data | Platelet count | Low | Low |
Hemoglobin | Often low | Low | |
Fibrin related markers | Markedly high | Slightly high | |
Prothrombin time | Often prolong | Normal | |
Antithrombin | Often low | Normal | |
Albumin | Often low | Normal | |
Creatinine | Often high | High | |
Total bilirubin, LDH | Often high | High | |
Treatments | Supportive therapy | Recommended | Recommended |
Blood transfusion (RBC, FFP) | Recommended | Recommended, | |
Blood transfusion (PC) | Recommended | Not recommended | |
Anticoagulant | Recommended (Japan) | Not mentioned | |
PE/FFP | Not mentioned | Recommended | |
Special treatment | AT, rhTM (Japan) | Hemodialysis (HUS), Eculizumab (aHUS), Rituximab (TTP) |