Disseminated Intravascular Coagulation Findings in 100 Patients
AMPAIWAN CHUANSUMRIT, M.D.*,
SAYOMPORN SIRINAVIN,M.D.*,
PONGSAK KHOWSATIDT,M.D.*,
PORNPIMOL PHUAPRADIT,M.D.*,
SATIT HOTRAKITYA, M.D.*,
SARAYUT SUPAPANACHART, M.D.*,
TEERACHAI CHANTAROJANASIRI, M.D.*,
PHONGJAN HATHIRAT, M.D.*
Affiliation : *Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
AbstractA retrospective study of 100 patients with disseminated intravascular coagulation from
1993 to 1997 is reported. Forty-five patients were neonates with a mean age of 12.6 days and 55
patients were infants, children and adolescents with a mean age of 6 years and 3 months. Most
of them (91.5%) had complicated underlying conditions which included congenital anomalies,
prematurity, malignancy, hematological and various diseases. Additionally, every patient had
triggering conditions commonly identified as gram-negative septicemia. Bleeding and thrombo-
embolic manifestations were found in 59.4 per cent and 19.8 per cent, respectively. The laboratory
findings revealed red blood cell fragmentation, 89.6 per cent and thrombocytopenia, 85.8 per cent.
Natural anticoagulants were studied in a few cases and revealed low levels of antithrombin III
and protein C. The prompt effective management included treatment of underlying diseases, iden-
tification and relief of triggering conditions, correction of thrombocytopenia and coagulopathy,
and fully supportive care. The overall case-fatality rate was 41.6 per cent which was not corre-
lated with age, underlying diseases, triggering conditions, manifestation of bleeding, thrombo-
embolism or shock, and exchange transfusion. However, a significant lower case-fatality rate
was found in patients with positive culture (25%) as compared to those with sepsis and negative
culture (51.7%) (p = 0.044). In addition, the febrile neutropenic patients, who showed good res-
ponse to the administrated granulocyte-colony stimulating factor (G-CSF), survived from the
DIC.
Keywords : DIC, Septicemia, Sepsis, Thromboembolism
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