Sepsis-associated disseminated intravascular coagulation and its differential diagnoses

Toshiaki Iba, Eizo Watanabe, Yutaka Umemura, Takeshi Wada, Kei Hayashida, Shigeki Kushimoto, Hideo Wada

Research output: Contribution to journalReview articlepeer-review

26 Citations (Scopus)

Abstract

Disseminated intravascular coagulation (DIC) is a common complication in sepsis. Since DIC not only promotes organ dysfunction but also is a strong prognostic factor, its diagnosis at the earliest possible timing is important. Thrombocytopenia is often present in patients with DIC but can also occur in a number of other critical conditions. Of note, many of the rare thrombocytopenic diseases require prompt diagnoses and specific treatments. To differentiate these diseases correctly, the phenotypic expressions must be considered and the different disease pathophysiologies must be understood. There are three major players in the background characteristics of thrombocytopenia: platelets, the coagulation system, and vascular endothelial cells. For example, the activation of coagulation is at the core of the pathogenesis of sepsis-associated DIC, while platelet aggregation is the essential mechanism in thrombotic thrombocytopenic purpura and endothelial damage is the hallmark of hemolytic uremic syndrome. Though each of the three players is important in all thrombocytopenic diseases, one of the three dominant players typically establishes the individual features of each disease. In this review, we introduce the pathogeneses, symptoms, diagnostic measures, and recent therapeutic advances for the major diseases that should be immediately differentiated from DIC in sepsis.

Original languageEnglish
Article number32
JournalJournal of Intensive Care
Volume7
Issue number1
DOIs
Publication statusPublished - 2019 May 20

Keywords

  • Disseminated intravascular coagulation
  • Hemolytic uremic syndrome
  • Heparin-induced thrombocytopenia
  • Sepsis
  • Thrombotic thrombocytopenic purpura

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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