Department of Haematology and Cell Biology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
National Health Laboratory Service, Universitas Academic Laboratory, Bloemfontein, South Africa.
Int J Lab Hematol. 2021 Oct;43(5):1174-1180. doi: 10.1111/ijlh.13461. Epub 2021 Feb 1.
Disseminated intravascular coagulation (DIC) is a feared complication of various systemic illnesses. We aimed to evaluate the laboratory requesting practices of clinicians, especially concerning the laboratory parameters, included in the International Society of Thrombosis and Haemostasis (ISTH) DIC score.
A retrospective descriptive study was performed and included data from DIC screen requests analysed at Universitas National Health Laboratory Service (NHLS) laboratory, Bloemfontein, South Africa, for one calendar year. Laboratory request forms were analysed, recording the pretest diagnosis and whether the diagnosis was associated with DIC. Parameters of the DIC screen, prothrombin time, activated partial thromboplastin time, thrombin time, d-dimer and fibrinogen were used to calculate the ITSH DIC score and diagnose heparin contamination. The platelet count, currently not part of the DIC screen test set, was also recorded.
A total of 778 DIC screen requests were processed. One hundred and eighty-three requests were excluded due to laboratory-defined rejection criteria, heparin contamination or for lacking an ISTH score parameter. Of the remaining 595 complete requests, 283 (47.7%) were laboratory-defined overt DIC. The pretest diagnosis was not predictive of either a positive or negative finding of overt DIC. The contribution of fibrinogen to assigning overt DIC was questionable.
The number of DIC screen requests received highlights the need for laboratory evidence of DIC. To improve laboratory DIC testing, the authors suggest critical evaluation of the contribution of the pretest diagnosis and fibrinogen in a prospective study and adding the platelet count in our local DIC test set.
弥散性血管内凝血（DIC）是多种全身性疾病的严重并发症。我们旨在评估临床医生的实验室申请实践，特别是关于国际血栓与止血学会（ISTH）DIC 评分中包含的实验室参数。
本研究采用回顾性描述性研究方法，纳入了南非布隆方丹大学国家卫生实验室服务（NHLS）实验室分析的一年中所有 DIC 筛查申请的数据。分析了实验室申请表格，记录了检测前诊断以及诊断是否与 DIC 相关。使用 DIC 筛查的参数，如凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、D-二聚体和纤维蛋白原来计算 ISTH DIC 评分并诊断肝素污染。还记录了血小板计数，目前不属于 DIC 筛查测试套件的一部分。
共处理了 778 次 DIC 筛查申请。由于实验室定义的排除标准、肝素污染或缺乏 ISTH 评分参数，183 次申请被排除在外。在剩余的 595 份完整申请中，283 份（47.7%）为实验室定义的显性 DIC。检测前诊断并不能预测显性 DIC 的阳性或阴性发现。纤维蛋白原对确定显性 DIC 的作用值得怀疑。
收到的 DIC 筛查申请数量突显了实验室对 DIC 的证据需求。为了改进实验室的 DIC 检测，作者建议在一项前瞻性研究中对检测前诊断和纤维蛋白原的作用进行批判性评估，并在当地 DIC 测试套件中添加血小板计数。
