Goksever Celik Hale, Celik Engin, Ozdemir Ismail, Ozge Savkli Ayse, Sanli Kamuran, Gorgen Husnu
a Department of Obstetrics and Gynecology , Saglik Bilimleri University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital , Istanbul , Turkey.
b Department of Obstetrics and Gynecology , Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey.
J Matern Fetal Neonatal Med. 2019 Mar;32(6):1004-1008. doi: 10.1080/14767058.2017.1397125. Epub 2017 Nov 7.
The diagnosis of disseminated intravascular coagulation (DIC) in obstetrics is complicated owing to physiological changes, particularly during late pregnancy and the postpartum period. Therefore, a pregnancy-modified DIC score that includes only three components of the International Society on Thrombosis and Hemostasis (ISTH) DIC score has been constructed. Our aim was to determine how many blood-transfused postpartum women actually had the diagnosis of overt DIC according to the modified ISTH score and had the correct indications for blood transfusion.
We retrospectively analyzed 279 women who had received transfusion of at least two units of blood for postpartum hemorrhage. We used the modified ISTH score for DIC, which is based on platelet count, fibrinogen concentration, and prothrombin time (PT) differences. A total score of 26 points or higher indicated overt DIC, whereas a score lower than 26 points represented nonovert DIC.
According to the modified ISTH score, 100 of the 279 patients (35.8%) had overt DIC, with a median DIC score of 37.0. Thirty-five percent of patients in the overt DIC group and 25.7% in the nonovert DIC group had received more than four units of blood. The levels of PT and activated partial thromboplastin time were higher, and the fibrinogen level was lower in patients with overt DIC.
According to the modified ISTH score, we found that blood transfusion was unnecessary in 179 of the 279 postpartum women (64.1%). If this scoring system is used to determine which patients should be transfused, unnecessary transfusions and their related risks and complications will be prevented.
由于生理变化，产科弥散性血管内凝血（DIC）的诊断较为复杂，尤其是在妊娠晚期和产后时期。因此，构建了一种仅包含国际血栓与止血学会（ISTH）DIC评分三个组成部分的妊娠改良DIC评分。我们的目的是确定根据改良ISTH评分，实际被诊断为显性DIC且有正确输血指征的产后输血女性的数量。
我们回顾性分析了279名因产后出血接受至少两单位输血的女性。我们使用基于血小板计数、纤维蛋白原浓度和凝血酶原时间（PT）差异的改良ISTH DIC评分。总分26分或更高表明为显性DIC，而低于26分表示非显性DIC。
根据改良ISTH评分，279例患者中有100例（35.8%）为显性DIC，DIC评分中位数为37.0。显性DIC组35%的患者和非显性DIC组25.7%的患者接受了超过四单位的血液。显性DIC患者的PT和活化部分凝血活酶时间水平较高，纤维蛋白原水平较低。
根据改良ISTH评分，我们发现279名产后女性中有179名（64.1%）无需输血。如果使用该评分系统来确定哪些患者应接受输血，将可避免不必要的输血及其相关风险和并发症。
