BACKGROUND: D-dimer is a specific marker of secondary fibrinolysis. D-dimer assay is widely used in the diagnosis of disseminated intravascular coagulation, deep vein thrombosis, pulmonary embolism, and arterial thromboembolism. Enzyme linked immunosorbent assays have been validated as the reference method for plasma D-dimer measurement, but it took long time. We evaluated the analytical performance of new automated coagulation system, ACL TOP, for quantification of D-dimer. METHODS: The total plasma D-dimer concentrations were measured by Nycocard and ACL TOP. To test the linearity, a serial dilution samples were prepared and measured. Between run precision of the ACL TOP D-dimer assay was evaluated with HemosIL D-Dimer controls for 20days. The correlation was evaluated using 75 plasma samples from patients. ACL TOP was evaluated according to CLSI guidelines. RESULTS: ACL TOP showed good linearity (r=0.9996) and between run coefficient of variation was within 4.0%. Coefficient of correlation between Nycocard and ACL TOP was 0.798. Positive concordance rate of ACL TOP was 67%, and negative concordance rate of ACL TOP was 80%. CONCLUSIONS: Since the ACL TOP showed a satisfactory precision, linearity, and comparative high correlation with Nycocard, and is more convenient and automatic than the Nycocard, it should be potentially beneficial in the clinical laboratories.
Diagnosis ; Disseminated Intravascular Coagulation ; Fibrinolysis ; Humans ; Plasma ; Pulmonary Embolism ; Thromboembolism ; Venous Thrombosis

Many screening tests have been developed for the detection of FDP for the last decade. Of these, Thrombo-Wellcotest was chosen in our laboratory as a screening procedure. For the last one year, there were 121 determinations performed on 82 patients. Of the patients suspected to have DIC, 27 patients with clinical, and laboratory evidence of DIC showed the Thrombo-Wellcotest to be positive with titers ranging from 1:5 to 1:1280. Those patients without clinical or laboratory evidence of DIC gave all negative results except for 7 positives with low titers. It is our opinion that the Thrombo-Wellcotest is a simple procedure to be performed by ordinary laboratory personnel and an inexpensive test which can be afforded by most of the patients. As a whole, the Thrombo-Wellcotest is considered to be a useful screening test for the detection of FDP in serum.
Disseminated Intravascular Coagulation/diagnosis* ; Fibrin Fibrinogen Degradation Products/analysis* ; Human ; Latex Fixation Tests

Amniotic fluid embolism is rare and unexpected but a life-threatening complication of pregnancy is accompanied by a high mortality rate. This syndrome usually occurs at the time of delivery. Classical clinical features are sudden onset of circulatory collapse, acute respiratory distress, disseminated intravascular coagulation and neurological impairment like seizure. The diagnosis is made by identifying clinically characteristics symptoms, and by exclusion of other cause. We report one case of a patient with amniotic fluid embolism, which showed atypical symptoms like seizure.
Amniotic Fluid* ; Diagnosis ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid* ; Female ; Humans ; Mortality ; Pregnancy ; Seizures* ; Shock

BACKGROUND: The criteria set by the International Society on Thrombosis and Hemostasis (ISTH) with the criteria of the Korean Society on Thrombosis and Hemostasis (KSTH) for the diagnosis of DIC was compared to evaluate the agreement between two criteria and the characteristics of each criteria. METHODS: Two hundred ninety-six adult patients with sepsis (57 pneumonia, 75 hepatobiliary and gastrointestinal infection, 25 urinary tract infection, 51 infection associated with malignant diseases and 84 other causes) were studied. The rate of agreement in the diagnosis of DIC by the two diagnostic systems was analyzed. Characteristics of each criteria was also analyzed by the comparison of laboratory criteria. RESULTS: The kappa coefficient and concordance rate, agreement parameters in the diagnosis of DIC by the two diagnostic systems was 0.78 and 89.5%, respectively. The median platelet count was lower and FDP level was higher in the patients diagnosed by ISTH criteria than in patients diagnosed by KSTH criteria. CONCLUSION: The agreement between ISTH and KSTH criteria was significantly high.
Adult ; Dacarbazine ; Diagnosis ; Disseminated Intravascular Coagulation* ; Hemostasis* ; Humans ; Platelet Count ; Pneumonia ; Sepsis ; Thrombosis* ; Urinary Tract Infections

Acute Human immunodeficiency virus (HIV) syndrome should be considered in any patient with possible HIV exposure who presents with acute febrile disease. The diagnosis of acute HIV syndrome is difficult because symptoms are those of common illness. A high index of suspicion and possibility of HIV exposure are important diagnostic clue. Early diagnosis during primary infection permit patient education and treatment that may delay disease progression and improve immune preservation and reconstitution. We report two cases of acute HIV syndrome presenting as an acute febrile disease. The first case had severe illness presenting as acute severe hepatitis and disseminated intravascular coagulation, and the second had relatively mild form of disease. Two cases started the treatment with highly active anti-retroviral therapy (HAART) and have been well now with no other complications.
Acquired Immunodeficiency Syndrome ; Diagnosis ; Disease Progression ; Disseminated Intravascular Coagulation ; Early Diagnosis ; Hepatitis ; HIV Infections ; HIV* ; Humans* ; Patient Education as Topic

Disseminated intravascular coagulation (DIC) is a major complication in sepsis patients. We compared the performance of five DIC diagnostic criteria, focusing on the prediction of mortality. One hundred patients with severe sepsis or septic shock admitted to intensive care unit (ICU) were enrolled. Routine DIC laboratory tests were performed over the first 4 days after admission. The overall ICU and 28-day mortality in DIC patients diagnosed from five criteria (International Society on Thrombosis and Haemostasis [ISTH], the Japanese Association for Acute Medicine [JAAM], the revised JAAM [R-JAAM], the Japanese Ministry of Health and Welfare [JMHW] and the Korean Society on Thrombosis and Hemostasis [KSTH]) were compared. Both KSTH and JMHW criteria showed superior performance than ISTH, JAAM and R-JAAM criteria in the prediction of overall ICU mortality in DIC patients (odds ratio 3.828 and 5.181, P = 0.018 and 0.006, 95% confidence interval 1.256–11.667 and 1.622–16.554, respectively) when applied at day 1 after admission, and survival analysis demonstrated significant prognostic impact of KSTH and JMHW criteria on the prediction of 28-day mortality (P = 0.007 and 0.049, respectively) when applied at day 1 after admission. In conclusion, both KSTH and JMHW criteria would be more useful than other three criteria in predicting prognosis in DIC patients with severe sepsis or septic shock.
Asian Continental Ancestry Group ; Dacarbazine ; Diagnosis ; Disseminated Intravascular Coagulation* ; Hemostasis ; Humans ; Intensive Care Units ; Mortality* ; Prognosis ; Sepsis* ; Shock, Septic ; Thrombosis

A diffuse alveolar hemorrhage (DAH) is a distinct form of pulmonary hemorrhage that originates from the pulmonary microcirculation. Disseminated intravascular coagulation (DIC) is one cause of DAH. Although HELLP syndrome associated with DIC can cause DAH, there are no published case reports that the authors are aware of. We report the case of a pregnant woman with HELLP syndrome who developed DAH. Because pregnant women with HELLP syndrome can develop DAH as a form of ARDS, a bronchoalveolar lavage may be used to make a differential diagnosis of this lung manifestation.
Bronchoalveolar Lavage ; Dacarbazine ; Diagnosis, Differential ; Disseminated Intravascular Coagulation ; Female ; HELLP Syndrome ; Hemorrhage* ; Humans ; Liver* ; Lung ; Microcirculation ; Pregnancy ; Pregnant Women

PURPOSE: We evaluated the diagnostic implications and therapeutic efficacy of antithrombin III(AT III) in the disseminated intravascular coagulation(DIC) of premature infants. METHODS: Ninety-two premature infants diagnosed with DIC and treated with AT III from March, 2000 to May, 2003 were retrospectively reviewed. Clinical manifestations, complete blood counts, coagulation tests, and AT III levels were compared between the two groups:definite DIC if clinical signs of DIC and AT III <70% with more than two abnormal laboratory parameters were present, and suspected DIC if not more than two abnormal laboratory parameters were present. RESULTS: AT III was given for an average of 3.2 days and no side effects related to the treatment were reported. The AT III levels increased significantly more than four fold with treatment in both groups. The clinical signs and laboratory values improved significantly after treatment. CONCLUSION: AT III level is a sensitive parameter in the diagnosis of DIC in premature infants, and it is useful as a treatment modality since it improves the clinical symptoms and the laboratory parameters without significant side effects.
Antithrombin III* ; Blood Cell Count ; Dacarbazine ; Diagnosis* ; Disseminated Intravascular Coagulation* ; Humans ; Infant, Newborn ; Infant, Premature* ; Retrospective Studies

Amniotic fluid embolism continues to be a life-threatening. It is an unexpected and rare complication of pregnancy often presenting with sudden maternal cardiovascular collapse, disseminated intravascular coagulation (DIC), and maternal death. In the past, the diagnosis of amniotic fluid embolism was made when a woman presented with one of those clinical hallmarks and at autopsy fetal squamous and amniotic fluid cells were found within the maternal pulmonary arteries. However, several studies have demonstrated that squamous cells, trophoblasts, and other debris of fetal origin may commonly be found in the central circulation of women with conditions other than amniotic fluid embolism. Thus, this finding is neither sensitive nor specific. We present a case that was diagnosed clinically as amniotic fluid embolism by characteristic signs and symptoms during the labor, resulting in maternal death.
Amniotic Fluid* ; Autopsy ; Dacarbazine ; Diagnosis ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid* ; Female ; Humans ; Maternal Death ; Pregnancy ; Pulmonary Artery ; Trophoblasts

BACKGROUND: The purpose of this study is to evaluate the diagnostic usefulness of the quantitation of D-dimer, thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 2 (F1 2) in patients with DIC or venous thrombosis. METHODS: The quantitation of D-dimer, TAT and F1 2 by ELISA (Behring, Germany) were done with the specimens from eighty eight patient plasma. The patients were classified as DIC, probable DIC and non-DIC based on the DIC criteria by reserach committee in Japan, and the patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) were included. RESULTS: All eighteen DIC patients showed the increased D-dimer ELISA and fourteen patients showed the increased TAT and F1 2. According to the results of quantitative D-dimer, TAT and F1 2 tests, probable DIC and the group with increased results of above three tests among non-DIC were considered as DIC. Two patients with PE showed increased results of above three tests. Among nine DVT patients, eight patients showed increased results of D-dimer ELISA and F1 2, but TAT was increased in only six patients. Among forty six patients with negative results of D-dimer semiquantitation (latex agglutination), twenty seven patients (59%) revealed increased results of D-dimer quantitation (ELISA). CONCLUSIONS: D-dimer quantitation by ELISA is the most sensitive test in the diagnosis of DIC and venous thrombosis. The quantitation of D-dimer, TAT and F1 2 can increase the diagnostic rate of DIC and venous thrombosis, and the developement of the new quatitating reagents with more rapid and individual procedures will contribute to the accurate and rapid diagnoses of them.
Dacarbazine ; Diagnosis ; Disseminated Intravascular Coagulation* ; Enzyme-Linked Immunosorbent Assay ; Humans ; Indicators and Reagents ; Japan ; Plasma ; Prothrombin* ; Pulmonary Embolism ; Venous Thrombosis*