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Table 1 JSTH’s DIC diagnostic criteria

From: The approval of revised diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

  Classification of type Basic Hematopoietic disorder Infectious
GCTs Platelet count (×103/μl) >120 0 p   >120 0 p
80 < − ≤ 120 1 p 80 < − ≤ 120 1 p
50 < − ≤ 80 2 p 50 < − ≤ 80 2 p
≤50 3 p ≤50 3 p
≥30% decrease w/in 24 h (*1) +1 p ≥30% decrease w/in 24 h (*1) +1 p
FDP (μg/ml) <10 0 p <10 0 p <10 0 p
10 ≤ − < 20 1 p 10 ≤ − < 20 1 p 10 ≤ − < 20 1 p
20 ≤ − < 40 2 p 20 ≤ − < 40 2 p 20 ≤ − < 40 2 p
≥40 3 p ≥40 3 p ≥40 3 p
Fibrinogen (mg/dl) >150 0 p >150 0 p  
100 < − ≤ 150 1 p 100 < − ≤ 150 1 p
≤100 2 p ≤100 2 p
Prothrombin time ratio <1.25 0 p <1.25 0 p <1.25 0 p
1.25 ≤ − < 1.67 1 p 1.25 ≤ − < 1.67 1 p 1.25 ≤ − < 1.67 1 p
≥1.67 2 p ≥1.67 2 p ≥1.67 2 p
HMMs Antithrombin (%) >70 0 p >70 0 p >70 0 p
≤70 1 p ≤70 1 p ≤70 1 p
TAT, SF or F1+2 <2-fold of normal upper limit 0 p <2-fold of normal upper limit 0 p <2-fold of normal upper limit 0 p
≥2-fold of normal upper limit 1 p ≥2-fold of normal upper limit 1 p ≥2-fold of normal upper limit 1 p
Liver failure (*2) No 0 p No 0 p No 0 p
Yes −3 p Yes −3 p Yes −3 p
DIC diagnosis ≥6 p ≥4 p ≥5 p
  1. Abbreviations: p points, GCT:global coagulation tests, HMMs hemostatic molecular markers
  2. (*1): For a platelet count of >50 × 103/μL, points will be added if the time-course conditions of decrease are met (no points will be added for a platelet count of ≤50 × 103/μL). The maximum score for the platelet count is 3 points.
  3. For institutions that do not measure FDP (institutions that measure only D-dimer), 1 point will be added if D-dimer increases ≥2-fold the normal upper limit. The upper limit of D-dimer is different among various D-dimer kits. However, in principle, FDP should also be measured and re-evaluation performed after the results are in hand. Fibrinogen levels are usually measured using thrombin time method in Japan.
  4. DIC may be excluded in case within normal range of FDP or D-dimer.
  5. Prothrombin time ratio: If ISI is close to 1.0, INR will also be acceptable (However, there is no evidence supporting recommendation of the use of PT-INR for diagnosis of DIC.). For determination of PT ratio, it is recommended to use normal pooled plasma.
  6. DIC may be excluded in case with elevated prothrombin time ratio due to vitamin K deficiency.
  7. Thrombin-antithrombin complex (TAT), soluble fibrin (SF), prothrombin fragment 1 + 2 (F1+2): For blood sampling in difficult cases and route blood sampling, false-high values may increase. Thus, in comparison with elevation of FDP and/or D-dimer, re-testing should be done if TAT and/or SF is markedly elevated. Confirmation is needed even if the results on the same day are not in time. Normal reference range is 56–213 pmol/L in F1+2, 0–3.2 μg/ml in SF and 0.3–1.5 ng/ml in TAT in Mie University Hospital.
  8. Regardless of the presence or absence of DIC immediately after surgery, changes in DIC-like markers such as elevation of TAT, SF, FDP, or D-dimer or a decrease in AT, may be observed, and judgment should be made with care.
  9. (*2) Liver failure: Corresponds to “a prothrombin time activity of ≤40% or an INR value of ≥1.5 due to severe liver dysfunction seen within 8 weeks of onset of initial symptoms following liver impairment that develops in a normal liver or a liver that is thought to exhibit normal liver function” (acute liver failure) or “cirrhosis with a Child-Pugh classification of B or C (≥7 points)” (chronic liver failure) that may be viral or autoimmune in origin, drug-induced, or caused by circulatory failure.”
  10. Even when DIC is strongly suspected but these diagnostic criteria are not met, there should be no interference with anti-coagulation therapy based on the physician’s judgment, but repeated evaluation is necessary