Last reviewed: 20 Sep 2020
Last updated: 08 Jan 2020



History and exam

Key diagnostic factors

  • presence of underlying disorders
  • oliguria, hypotension, or tachycardia
  • purpura fulminans, gangrene, or acral cyanosis
  • delirium or coma
  • petechiae, ecchymosis, oozing, or haematuria

Risk factors

  • major trauma/burn/organ destruction or sepsis/severe infection
  • severe obstetric disorders or complications
  • solid tumours and haematological malignancies
  • severe toxic or immunological reactions
  • major vascular disorders (large aortic aneurysms or giant haemangiomas)

Diagnostic investigations

1st investigations to order

  • platelet count
  • prothrombin time (PT)
  • fibrinogen
  • D-dimer/fibrin degradation products
  • activated partial thromboplastin time (aPTT)
  • imaging studies or other tests
More 1st investigations to order

Investigations to consider

  • thrombin time
  • protamine test
  • factor V, VIII, X, XIII
More investigations to consider

Emerging tests

  • inflammatory cytokines
  • D-dimer (monoclonal antibody test)
  • antithrombin III
  • fibrinopeptide A (FPA)
  • prothrombin fragment 1 and 2
More emerging tests

Treatment algorithm


Assistant Professor - Gratis

LSU Health Sciences Center Shreveport (LSUHSC-S)



Staff Anesthesiologist

JPS Health Network

Department of Anesthesiology

Fort Worth



HW declares that he has no competing interests.

Dr Haibo Wang would like to gratefully acknowledge Dr Frank G. Zavisca, a previous contributor to this topic.

Peer reviewersVIEW ALL

Professor and Chairman

Department of Anesthesiology

LSU School of Medicine

New Orleans



AK is on the speakers' bureau of Baxter Corporation and Hospira Corporation.

Professor of Haematology

University of Liverpool




CHT is an author of a reference cited in this topic.

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