Disseminated intravascular coagulation. Objective laboratory diagnostic criteria and guidelines for management.

Current concepts of the etiology, pathophysiology, clinical and laboratory diagnosis, and management of fulminant and low-grade DIC have been presented. Considerable attention has been devoted to interrelationships within the hemostasis system. Only by clearly understanding these pathophysiological interrelationships can the clinician and laboratory scientist appreciate the divergent and wide spectrum of often confusing clinical and laboratory findings in patients with DIC. In this discussion, objective clinical and laboratory criteria for the diagnosis of DIC have been delineated, thus eradicating needless confusion and empirical decisions regarding the diagnosis. Many therapeutic decisions to be made are controversial and will remain so until more is published about specific therapeutic modalities and survival patterns. Also, therapy must be highly individualized depending on the nature of DIC, age, etiology of DIC, site and severity of hemorrhage or thrombosis, and hemodynamic and other clinical parameters. Also presented are clear criteria for the severity of DIC and objective criteria for defining a response to therapy. Because it frequently is difficult for the individual physician to decide when to stop often extensive and expensive therapy, objective criteria whereby therapy may be stopped, as it is deemed that continuation is most likely fruitless, have been presented as a guideline. Many syndromes, which frequently are organ-specific, share common pathophysiology with DIC but are typically identified as an independent disease entity, for example, hemolytic uremic syndrome, adult shock-lung syndrome, eclampsia, and many other isolated organ-specific disorders.