Disseminated Intravascular Coagulation (DIC) Profile, Comprehensive Plus

CPT: 85049; 85220; 85240; 85300; 85379; 85384; 85410; 85420; 85610; 85730
Print Share

Test Details

Test Includes

A2-antiplasmin; antithrombin activity; D-dimer; factor V activity; factor VIII activity; fibrinogen antigen; international normalized ratio (INR); plasminogen; platelet count; prolonged activated partial thromboplastin time (aPTT); prothrombin time (PT)

Use

Identify the presence and follow the course of disseminated intravascular coagulation (DIC), including abnormalities in platelet count, fibrinogen, fibrin split products, and fibrinolytic activity

Methodology

See individual tests.

Additional Information

Disseminated intravascular coagulation (DIC) is an acquired disorder that typically occurs secondary to an underlying condition.6-8 DIC can develop secondary to conditions including obstetric accidents (placental abruption, septic abortion), intravascular hemolysis (transfusion reactions), septicemia, viremia, metastatic malignancy, leukemia, burns, severe trauma, acute liver disease, prosthetic devices, and vascular disorders. Low grade DIC can also be observed in cardiovascular, autoimmune, renal vascular, hematologic, and inflammatory disorders. DIC occurs when the normal hemostatic balance is disrupted as the result of a systemic activation of the procoagulant and fibrinolytic systems.7 An excessive amount of thrombin is generated as the result of the uncontrolled release of tissue factor (TF) into the circulation. This can occur as the result of damage to the vascular membrane or as a response to agents that stimulate TF release from endothelial cells. Cytokines produced in septic shock or endotoxin from gram-negative bacteria can induce excessive TF release.6 TF in turn initiates the extrinsic pathway of coagulation and, through the action of thrombin, the entire coagulation cascade. Thrombin production is normally limited by tissue factor pathway inhibitor, antithrombin, and protein C anticoagulant mechanisms. Under normal circumstances, the mononuclear-phagocyte system removes TF from the circulation while hepatocytes serve to clear activated coagulation proteases and tissue-plasminogen activator from the circulation.7 In DIC, hemostatic control by the natural anticoagulant mechanisms is overwhelmed and thrombin production is unchecked.

The clinical manifestations of DIC can be predominantly thrombotic, fibrinolytic with hemorrhage, or both.6-8 The excessive thrombin generation that occurs in DIC can result in the deposition of fibrin in the microvasculature, leading to thrombosis and tissue ischemia. Overactivation of the coagulation cascade can, in turn, result in bleeding due to the depletion of platelets, fibrinogen, prothrombin, and other hemostatic proteins in what is referred to as a consumption coagulopathy. Increased fibrin production triggers the fibrinolytic system with the conversion of plasminogen to plasmin. Plasmin, in turn, catalyzes the conversion of fibrin to D-dimer and other fibrinogen degradation products. As plasmin levels increase, the levels of its inhibitor, α2-antiplasmin, become overwhelmed until free plasmin is left to circulate uncontrolled. Free plasmin breaks down both fibrinogen and fibrin-producing degradation products that can interfere with platelet aggregation, further increasing the risk of bleeding.

The symptoms of DIC in certain conditions can be exacerbated by other aspects of the disease. Hepatic dysfunction can lead to diminished production of procoagulant factors and impair the clearance of fibrinogen degradation products, increasing the risk of bleeding.6 Abnormal bone marrow function found in leukemia can lead to reduced platelet production and can adversely impact primary hemostasis. D-dimer can be useful in distinguishing DIC from other conditions associated with bleeding, such as vitamin K deficiency and the rare condition, primary fibrinolysis, since these conditions are not associated with excessive thrombin generation.6

Specimen Requirements

Specimen

Whole blood and plasma, frozen

Volume

4.5 mL sodium citrate whole blood, 5 mL EDTA whole blood, and 6 mL frozen plasma (2 mL in each of two tubes), one tube citrated whole blood

Container

Lavender-top (EDTA) tube and blue-top (sodium citrate) tubes

Patient Preparation

None

Collection

Citrated plasma samples should be collected by double centrifugation. Blood should be collected in a blue-top tube containing 3.2% buffered sodium citrate.1 Evacuated collection tubes must be filled to completion to ensure a proper blood to anticoagulant ratio.2,3 The sample should be mixed immediately by gentle inversion at least six times to ensure adequate mixing of the anticoagulant with the blood. A discard tube is not required prior to collection of coagulation samples, except when using a winged blood collection device (ie, "butterfly"), in which case a discard tube should be used.4,5 When noncitrate tubes are collected for other tests, collect sterile and nonadditive (red-top) tubes prior to citrate (blue-top) tubes. Any tube containing an alternate anticoagulant should be collected after the blue-top tube. Gel-barrier tubes and serum tubes with clot initiators should also be collected after the citrate tubes. Centrifuge for 10 minutes and carefully remove 2/3 of the plasma using a plastic transfer pipette, being careful not to disturb the cells. Deliver to a plastic transport tube, cap, and recentrifuge for 10 minutes. Use a second plastic pipette to remove the plasma, staying clear of the platelets at the bottom of the tube. Transfer the plasma into a LabCorp PP transpak frozen purple tube with screw cap (LabCorp N° 49482). Freeze immediately and maintain frozen until tested. To avoid delays in turnaround time when requesting multiple tests on frozen samples, please submit separate frozen specimens for each test requested.

Please print and use the Volume Guide for Coagulation Testing to ensure proper draw volume.

Storage Instructions

Maintain whole blood at room temperature. Freeze plasma.

Causes for Rejection

Severe hemolysis; improper labeling; clotted specimen; specimen diluted with IV fluids; samples thawed in transit; improper sample type; sample out of stability

Clinical Information

Special Instructions

If the patient's hematocrit exceeds 55%, the volume of citrate in the collection tube must be adjusted. Refer to Coagulation Collection Procedures for directions.

Footnotes

1. Adcock DM, Kressin DC, Marlar RA. Effect of 3.2% vs 3.8% sodium citrate concentration on routine coagulation testing. Am J Clin Pathol. 1997 Jan; 107(1):105-110. 8980376
2. Reneke J, Etzell J, Leslie S, Ng VL, Gottfried EL. Prolonged prothrombin time and activated partial thromboplastin time due to underfilled specimen tubes with 109 mmol/L (3.2%) citrate anticoagulant. Am J Clin Pathol. 1998 Jun; 109(6):754-757. 9620035
3. National Committee for Clinical Laboratory Standardization. Collection, Transport, and Processing of Blood Specimens for Coagulation Testing and General Performance of Coagulation Assays; Approved Guideline. 5th ed. Villanova, Pa: NCCLS; 2008. Document H21-A5:28(5).
4. Gottfried EL, Adachi MM. Prothrombin time and activated partial thromboplastin time can be performed on the first tube. Am J Clin Pathol. 1997 Jun; 107(6):681-683. 9169665
5. McGlasson DL, More L, Best HA, Norris WL, Doe RH, Ray H. Drawing specimens for coagulation testing: Is a second tube necessary? Clin Lab Sci. 1999 May-Jun; 12(3):137-139. 10539100
6. Carey MJ, Rodgers GM. Disseminated intravascular coagulation: Clinical and laboratory aspects. Am J Hematol. 1998 Sep; 59(1):65-73. 9723580
7. Yu M, Nardella A, Pechet L. Screening tests of disseminated intravascular coagulation: Guidelines for rapid and specific laboratory diagnosis.Crit Care Med. 2002 Jun; 28(6):1777-1780. 10890618
8. Mammen EF. Disseminated intravascular coagulation (DIC). Clin Lab Sci. 2000 Fall; 13(4):239-245. 11586511

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
117853 DIC Comprehensive Plus 015040 Antithrombin Activity % 27811-9
117853 DIC Comprehensive Plus 117740 Alpha-2-Antiplasmin % 27810-1
117853 DIC Comprehensive Plus 001610 Fibrinogen Activity mg/dL 3255-7
117853 DIC Comprehensive Plus 015172 Platelets x10E3/uL 777-3
117853 DIC Comprehensive Plus 115107 INR 6301-6
117853 DIC Comprehensive Plus 015289 Prothrombin Time sec 5902-2
117853 DIC Comprehensive Plus 015116 aPTT sec 14979-9
117853 DIC Comprehensive Plus 115206 D-Dimer mg/L FEU 48065-7
117853 DIC Comprehensive Plus 086249 Factor V Activity % 3193-0
117853 DIC Comprehensive Plus 086264 Factor VIII Activity % 3209-4
117853 DIC Comprehensive Plus 117714 Plasminogen % 5970-9
Reflex Table for INR
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 115109 INR (Thromborel-S) 115109 INR (Thromborel-S) 6301-6
Reflex Table for Prothrombin Time
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 015290 PT (Thromborel-S) 015290 PT (Thromborel-S) sec 5902-2

For Providers

Please login to order a test.

 

© 2017  Laboratory Corporation of America® Holdings and Lexi-Comp Inc. All Rights Reserved.

CPT Statement/Profile Statement

The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf