Last reviewed: June 2020
Last updated: January  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 hematuria

Risk factors

  • major trauma/burn/organ destruction or sepsis/severe infection
  • severe obstetric disorders or complications
  • solid tumors and hematologic malignancies
  • severe toxic or immunologic reactions
  • major vascular disorders (large aortic aneurysms or giant hemangiomas)

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

Contributors

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.

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

LA

Disclosures

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

Professor of Haematology

University of Liverpool

Liverpool

UK

Disclosures

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

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