<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukae...<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. <strong>Materials and Methods:</strong> This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. <strong>Results: </strong>By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage.<strong> Conclusion:</strong> Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.展开更多
This review describes disseminated intravascular coagulation(DIC) as a syndrome in which hemostatic factors are activated and products are generated. This syndrome ranges in severity from an obvious decompensated coag...This review describes disseminated intravascular coagulation(DIC) as a syndrome in which hemostatic factors are activated and products are generated. This syndrome ranges in severity from an obvious decompensated coagulopathy (overt-DIC) to the subclinical compensated activation of hemostatic factors(non-overt DIC). Ths first part of this review emphasizes two points: First, activation of the hemostatic system is controlled by a vast network of capillaries and venules through anticoagulant and antiinflammatory regulatory factors that operate from the endothelium( e. G. , protein C and thrombomodulin, tissue factor pathway inhibitor).展开更多
Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy...Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy and PHI remains unclear. The present study utilized a scoring system defined by the International Society of Thrombosis and Haemostasis to investigate whether a high DIC score is predictive for PHI. This study was a multicenter prospective design involving four hospitals, a 6-month observation, and follow-up. Of 352 traumatic brain injury （TBI） patients, serial CT scan indicated approximately one third of patients developed progressive hemorrhage, which was most frequently observed in the frontal, temporal, and orbitofrontal lobes of patients with brain contusion. PHI-positive patients exhibited poor prognosis, as indicated by prolonged length of hospital/intensive care unit stay and high mortality. More importantly, a DIC score after TBI, as well as patient age and sex, could serve as predictors for PHI. In addition, DIC scores were closely associated with injury severity. Therefore, the DIC scoring system facilitated early PHI diagnosis in TBI patients, and DIC scores might serve as a valuable predictor for TBI patients with PHI.展开更多
目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disse...目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disseminated intravascular coagulation scoring,CDICS)三种弥漫性血管内凝血(disseminated intravascular coagulation,DIC)评分在评估脓毒性休克患者器官功能损伤和预后评估中的应用价值。方法回顾性分析96例脓毒性休克患者,记录临床资料及28d病死率,进行ISTH评分、JAAM评分及CDICS评分,并分为DIC组和非DIC(NODIC)组,分析两组器官功能损伤、危重程度及预后的差异。结果①脓毒性休克患者中,生存组的ISTH评分低于死亡组,分别为3(2,5)和4(3,6),差异有统计学意义(P=0.049);但生存组和死亡组的JAAM评分、CDICS评分差异均无统计学意义(P>0.05);②脓毒性休克患者中,ISTH评分、JAAM评分、CDICS评分与APACHEⅡ评分、SOFA评分均具有一定的相关性,r值分别为0.335、0.434、0.444(vs.APACHEⅡ评分)和0.443、0.559、0.632(vs.SOFA评分);③以不同DIC评分为DIC诊断标准,DIC组和NODIC组死亡构成比差异无统计学意义(P>0.05),但DIC组的危重度(APACHEⅡ评分)和器官功能损伤程度(SOFA评分)均明显高于NODIC组(P<0.05);④采用ROC曲线分析三种DIC评分预测脓毒性休克28d病死率,曲线下面积分别为0.626、0.578、0.613。结论ISTH评分、JAAM评分、CDICS评分有助于评估脓毒性休克患者的器官功能损伤和危重程度,但对28d病死率的预测价值欠佳,CDICS评分应用于脓毒性休克时与ISTH评分、JAAM评分具有类似的评估价值。展开更多
文摘<strong>Background: </strong>Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. <strong>Materials and Methods:</strong> This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. <strong>Results: </strong>By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034). No significant association was found between presence of DIC and age, gender, bleeding at presentation, morphological type, WBC count or peripheral blast percentage.<strong> Conclusion:</strong> Abnormalities of DIC parameters in common in patients with AML. A significant portion of patients with DIC have no apparent symptom or bleeding. So, routine screening of DIC parameter at presentation is recommended for early diagnosis & effective management of DIC.
文摘This review describes disseminated intravascular coagulation(DIC) as a syndrome in which hemostatic factors are activated and products are generated. This syndrome ranges in severity from an obvious decompensated coagulopathy (overt-DIC) to the subclinical compensated activation of hemostatic factors(non-overt DIC). Ths first part of this review emphasizes two points: First, activation of the hemostatic system is controlled by a vast network of capillaries and venules through anticoagulant and antiinflammatory regulatory factors that operate from the endothelium( e. G. , protein C and thrombomodulin, tissue factor pathway inhibitor).
基金the National Natural Science Foundation of China,No. 81000518 and 30770824China Postdoc-toral Science Foundation,No. 201003237+2 种基金the Scien-tific Research Foundation for the Returned Overseas Chinese Scholars,Ministry of Education of ChinaShang-hai Pujiang Program,No. 09PJ1408300the Science and Technology Commission of Shanghai Municipality Project,No. 10JC1402300.
文摘Coagulation abnormalities, such as disseminated intravascular coagulation （DIC）, are associated with progressive hemcrrhagic injury （PHI） following head trauma. However, the exact relationship between coagulopathy and PHI remains unclear. The present study utilized a scoring system defined by the International Society of Thrombosis and Haemostasis to investigate whether a high DIC score is predictive for PHI. This study was a multicenter prospective design involving four hospitals, a 6-month observation, and follow-up. Of 352 traumatic brain injury （TBI） patients, serial CT scan indicated approximately one third of patients developed progressive hemorrhage, which was most frequently observed in the frontal, temporal, and orbitofrontal lobes of patients with brain contusion. PHI-positive patients exhibited poor prognosis, as indicated by prolonged length of hospital/intensive care unit stay and high mortality. More importantly, a DIC score after TBI, as well as patient age and sex, could serve as predictors for PHI. In addition, DIC scores were closely associated with injury severity. Therefore, the DIC scoring system facilitated early PHI diagnosis in TBI patients, and DIC scores might serve as a valuable predictor for TBI patients with PHI.
文摘目的探讨国际血栓与止血协会(The International Society of Thrombisis and Hemostasis,ISTH)评分标准、日本急诊医学学会(Japanese Association for Acute Medicin,JAAM)、评分标准和中国弥散性血管内凝血诊断积分系统(Cheinese disseminated intravascular coagulation scoring,CDICS)三种弥漫性血管内凝血(disseminated intravascular coagulation,DIC)评分在评估脓毒性休克患者器官功能损伤和预后评估中的应用价值。方法回顾性分析96例脓毒性休克患者,记录临床资料及28d病死率,进行ISTH评分、JAAM评分及CDICS评分,并分为DIC组和非DIC(NODIC)组,分析两组器官功能损伤、危重程度及预后的差异。结果①脓毒性休克患者中,生存组的ISTH评分低于死亡组,分别为3(2,5)和4(3,6),差异有统计学意义(P=0.049);但生存组和死亡组的JAAM评分、CDICS评分差异均无统计学意义(P>0.05);②脓毒性休克患者中,ISTH评分、JAAM评分、CDICS评分与APACHEⅡ评分、SOFA评分均具有一定的相关性,r值分别为0.335、0.434、0.444(vs.APACHEⅡ评分)和0.443、0.559、0.632(vs.SOFA评分);③以不同DIC评分为DIC诊断标准,DIC组和NODIC组死亡构成比差异无统计学意义(P>0.05),但DIC组的危重度(APACHEⅡ评分)和器官功能损伤程度(SOFA评分)均明显高于NODIC组(P<0.05);④采用ROC曲线分析三种DIC评分预测脓毒性休克28d病死率,曲线下面积分别为0.626、0.578、0.613。结论ISTH评分、JAAM评分、CDICS评分有助于评估脓毒性休克患者的器官功能损伤和危重程度,但对28d病死率的预测价值欠佳,CDICS评分应用于脓毒性休克时与ISTH评分、JAAM评分具有类似的评估价值。
