Table 5 Diagnostic Criteria Comparison between acute DIC and EA-VMTD-associated HC
1 Diagnostic criteria of “acute DIC” (conceptual) ● Underlying disease - Sepsis and other critical illnesses (including COVID-19) ● Character of blood clots - Fibrin clots or microthromobi (different claims in the literature) ● Pathogenetic mechanism: consumption coagulopathy via TF path (resulting in consumption of platelets, fibrinogen, FVIII and FV.) ● Coagulation test results - Thrombocytopenia - Decreased fibrinogen, FVIII, FV (due to consumption) - Normal FVII (not consumed) - Prolonged PT - Prolonged aPTT - Positive D-dimer/FDP (due to fibrinolysis) ● Hematologic manifestations - Thromobocytopenia - MAHA 2 Diagnostic criteria of EA-VMTD-associated hepatic coagulopathy ● Underlying disease - Sepsis and other critical illnesses (including COVID-19) ● Character of blood clots - Always microthrombi ● Pathogenetic mechanism: EA-VMTD via ULVWF path and hepatic involvement (resulting in consumption of platelets, endothelial exocytosis of ULVWF/FVIII, and decreased liver dependent factors.) ● Coagulation test results - Thrombocytopenia - Increased fibrinogen in early stage and decreased fibrinogen in late stage of liver disease (from liver necrosis in early stage and decreased synthesis in late stage) - Markedly increased ULVWF/VWF/VWF expression (due to exocytosis) - Markedly increased FVIII activity (due to exocytosis) - Markedly decreased FVII activity (due to liver damage) - Mildly decreased FV (due to liver damage) - Prolonged PT - Prolonged aPTT - Positive D-dimer/FDP (due to live tissue damage and fibrinogenolysis) ● Hematologic manifestations - Thrombocytopenia - MAHA |