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Table 3 Differential features of sepsis-associated “DIC” and other thrombo-coagulopathies

From: Sepsis and septic shock: endothelial molecular pathogenesis associated with vascular microthrombotic disease

  “DIC” without hepatic coagulopathy “DIC” with hepatic coagulopathy EA-VMTD/DIT without hepatic coagulopathy True DIC
Associated disease Sepsis Other critical illnesses Sepsis Other critical illnesses FHF Sepsis Other critical illnesses APL
Mechanism
 Complement activation + + + No evidence
 Endotheliopathy + + + No evidence
 Inflammatory path Activated Activated Activated No evidence
 Activated hemostatic path ULVWF ULVWF ULVWF Aberrant TF path
 Thrombogenesis Via micothrombogenesis Via micothrombogenesis Via micothrombogenesis Via fibrinogenesis
 Liver involvement None FHF None Unlikely to occur
Pathology
 Coagulation disorder VMTD VMTD with FHF VMTD Hemorrhagic disorder
 Character of blood clots Microthrombi Microthrombi Microthrmbi Fibrin clots
 Nature of blood clot Platelet + ULVWF Platelet +ULVWF Platelet +ULVWF Fibrin meshes
Hematology
 Platelet Decreased Decreased Decreased Decreased due to APL
 MAHA + + +
 FVIII Normal/increased Markedly increased Normal/increased Markedly decreased
 PT/aPTT Normal Prolonged Normal Prolonged
 Fibrinogen Normal Decreased Normal Decreased
Clinical Phenotype MODS MODS MODS Hemorrhagic syndrome
TTP-like syndrome TTP-like syndrome TTP-like syndrome
Chronic “DIC” Acute “DIC” EA-VMTD/DIT
FHF
Correct diagnosis EA-VMTD/DIT EA-VMTD/DIT with hepatic coagulopathy EA-VMTD/DIT True DIC
Disease designation EA-VMTD EA-VMTD with hepatic coagulopathy EA-VMTD Consumption coagulopathy
  1. Abbreviations: APL acute promyelocytic leukemia, DIC disseminated intravascular coagulation, “DIC” ill-founded DIC, DIT disseminated intravascular microthrombosis, FHF fulminant hepatic failure, MAHA microangiopathic hemolytic anemia, MODS multiorgan dysfunction syndrome, PT prothrombin time, aPTT activated partial thromboplastin time, TTP thrombotic thrombocytopenic purpura, ULVWF unusually large von Willebrand factor multimers, EA-VMTD endotheliopathy-associated vascular microthrombotic disease
  2. aPlease note that “DIC” without hepatic coagulopathy is exactly the same to EA-VMTD/DIT without hepatic coagulopathy, which is also consistent with the thesis that “DIC” is DIT