Wada Hideo, Matsumoto Takeshi, Suzuki Kei, Imai Hiroshi, Katayama Naoyuki, Iba Toshiaki, Matsumoto Masanori
1Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Mie 514-8507 Japan.
2Division of Blood Transfusion Medicine and Cell Therapy, Mie University Graduate School of Medicine, Tsu, Japan.
Thromb J. 2018 Jul 11;16:14. doi: 10.1186/s12959-018-0168-2. eCollection 2018.
Both disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) cause microvascular thrombosis associated with thrombocytopenia, bleeding tendency and organ failure.
The frequency of DIC is higher than that of thrombotic thrombocytopenic purpura (TTP). Many patients with TMA are diagnosed with DIC, but only about 15% of DIC patients are diagnosed with TMA. Hyperfibrinolysis is observed in most patients with DIC, and microangiopathic hemolytic anemia is observed in most patients with TMA. Markedly decreased ADAMTS13 activity, the presence of Shiga-toxin-producing (STEC) and abnormality of the complement system are useful for the diagnosis of TTP, STEC-hemolytic uremic syndrome (HUS)and atypical HUS, respectively. However, there are no specific biomarkers for the diagnosis of DIC.
Although DIC and TMA are similar appearances, all coagulation, fibrinolysis and platelet systems are activated in DIC, and only platelets are markedly activated in TMA.
弥散性血管内凝血（DIC）和血栓性微血管病（TMA）均可导致微血管血栓形成，伴有血小板减少、出血倾向和器官衰竭。
DIC的发生率高于血栓性血小板减少性紫癜（TTP）。许多TMA患者被诊断为DIC，但只有约15%的DIC患者被诊断为TMA。大多数DIC患者存在高纤维蛋白溶解现象，而大多数TMA患者存在微血管病性溶血性贫血。ADAMTS13活性显著降低、产志贺毒素（STEC）的存在以及补体系统异常分别有助于TTP、STEC溶血性尿毒症综合征（HUS）和非典型HUS的诊断。然而，目前尚无诊断DIC的特异性生物标志物。
尽管DIC和TMA表现相似，但DIC时所有凝血、纤维蛋白溶解和血小板系统均被激活，而TMA时仅血小板被显著激活。
