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Table 2 Hemostatic characteristics and mechanisms between “DIC”/DIC and EA-VMTD-associated hepatic coagulopathy

From: Disseminated intravascular coagulation: new identity as endotheliopathy-associated vascular microthrombotic disease based on in vivo hemostasis and endothelial molecular pathogenesis

  Acute “DIC” (per current concept*) EA-VMTD-associated hepatic coagulopathy DIC of APL
Clinical settings Critical illnesses (e.g., sepsis; trauma) Critical illnesses
(e.g., sepsis; trauma)
APL
Thrombosis form Claim to be fibrin clots* by some, but are microthrombi by pathology Microthrombi Fibrin clots
Pathogenesis Fibrinogenesis* Microthrombogenesis Fibrinogenesis
Hemostatic path TF path activation* Lone activation of ULVWF path Aberrant TF path activation
Coagulation study
 Platelet count Low Often low Low (due to leukemia)
 PT Prolonged Prolonged Prolonged
 aPTT Prolonged Prolonged Prolonged
 FVIII Supposedly markedly ↓ (due to consumption) Markedly ↑ (due to endothelial release) Markedly ↓ (due to consumption)
 FV Supposedly ↓ (due to consumption) Moderately ↓ (due to live necrosis) Decreased (due to consumption)
 FVII Supposedly normal (because not consumed) Markedly ↓ (due to liver disease) Normal
 Fibrinogen Supposedly ↓ (due to consumption) Markedly ↑ (due to release in early liver damage)
Markedly ↓ (due to liver failure in late stage)
Decreased (due to consumption)
 ULVWF/VWF Supposedly normal (due to no participation) Markedly ↑ (due to endothelial exocytosis) Negative (due to no endotheliopathy)
 D-dimer/FDP Positive (due to “fibrinolysis*”) Positive (due to fibrinogenolysis in liver damage) Positive (due to fibrinolysis)
Clinical syndrome Supposedly consumption coagulopathy*, but this disease with the above Lab findings does not exist in real patient.
(Please see text for COVID-19 interpretation)
EA-VMTD (i.e., DIT) with hepatic coagulopathy Consumption coagulopathy of APL
Correct diagnosis Does not exist, but it should be → → →→ EA-VMTD with HC True DIC (fibrin clot disease)
  1. Abbreviations: APL Acute promyelocytic leukemia, DIC Disseminated intravascular coagulation, “DIC” False DIC, DIT Disseminated intravascular microthrombosis, EA-VMTD Endotheliopathy-associated vascular microthrombotic disease, FDP Fibrin degradation products, HC Hepatic coagulopathy, TF Tissue factor, TTP Thrombotic thrombocytopenic purpura
  2. *Wrongfully designated pathogenesis and concept