Last reviewed: 26 Jun 2021
Last updated: 08 Jan 2020

Summary

Definition

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

Investigations to consider

  • thrombin time
  • protamine test
  • factor V, VIII, X, XIII

Emerging tests

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

Treatment algorithm

Contributors

Authors

Haibo Wang, MD, PhD

Assistant Professor - Gratis

LSU Health Sciences Center Shreveport (LSUHSC-S)

Shreveport

LA

Staff Anesthesiologist

JPS Health Network

Department of Anesthesiology

Fort Worth

TX

Disclosures

HW declares that he has no competing interests.

Acknowledgements

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

Disclosures

FGZ declares he has no competing interests.

Peer reviewers

Alan Kaye, MD, PhD, DABPM

Professor and Chairman

Department of Anesthesiology

LSU School of Medicine

New Orleans

LA

Disclosures

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

Cheng-Hock Toh, MB, ChB, MD, FRCP, FRCPath

Professor of Haematology

University of Liverpool

Liverpool

UK

Disclosures

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

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