title: Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis.
abstract: Disseminated intravascular coagulation (DIC) is a serious disease that, in the presence of underlying disease, causes persistent, generalized, marked coagulation activation. Early treatment based on an appropriate diagnosis is very important for improving patients' prognosis, to which end diagnostic criteria play a key role. Several criteria have been proposed, but each has its strengths and weaknesses, and improved criteria are needed. Widespread use of coagulofibrinolytic markers has elucidated that the pathology of DIC differs greatly as a function of the underlying disease. Thus, discriminating use of DIC diagnostic criteria that take underlying diseases into account is important. DIC diagnostic criteria that are well known in Japan include the Japanese Ministry of Health and Welfare's old DIC diagnostic criteria (JMHW criteria), the International Society on Thrombosis and Haemostasis's DIC diagnostic criteria (ISTH criteria), and the Japanese Association for Acute Medicine's acute-stage DIC diagnostic criteria (JAAM criteria). Those criteria have their respective drawbacks: the sensitivity of the ISTH criteria is poor, the JAAM criteria cannot be applied to all underlying diseases, and the JMHW criteria have poor sensitivity in the case of infections, do not use molecular markers, and result in misdiagnosis. The Japanese Society on Thrombosis and Hemostasis's newly proposed provisional draft DIC diagnostic criteria (new criteria) use diagnostic criteria classifications of "hematopoietic disorder type", "infectious type", and "basic type" based on the underlying pathology. For the hematopoietic disorder type the platelet count is omitted from the score, while for the infectious type, fibrinogen is omitted from the score. Also, points are added if the platelet count decreases with time. In the new criteria, molecular markers and antithrombin activity have been newly included, and as a countermeasure for misdiagnosis, 3 points are deducted if there is liver failure. In this paper, we discuss various problems encountered with DIC diagnosis, and we describe the new criteria together with the events that led to their creation. These new diagnostic criteria take into account the underlying diseases of wide area, and we expect that they will serve clinicians well due to the above adaptations and improvements.
authors.affiliation: Department of Internal Medicine (III), Kanazawa University School of Medicine, 13-1, Takaramachi, Kanazawa, 920-8641 Japan.
authors.forename: Hidesaku
authors.identifier: 0000-0003-1834-1690
authors.initials: H
authors.lastname: Asakura
authors.affiliation: Department of Internal Medicine, Niigata Prefectural Kamo Hospital, 1-9-1 Aomicho, Kamo, Niigata 959-1397 Japan.
authors.forename: Hoyu
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Department of Laboratory Medicine, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-Cho, Takasaki, Gunma 370-0829 Japan.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Uchiyama
authors.affiliation: Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Eguchi
authors.affiliation: Gastroenterology and Hepatology Center, Kitakyushu City Yahata Hospital, 4-18-1, Nishihon-machi, Yahatahigashi-ku, Kitakyushu, Fukuoka 805-8534 Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Department of Hematology, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi-Ku, Tokyo, 173-8605 Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kawasugi
authors.affiliation: Department of Clinical and Laboratory Medicine, Tokyo Saiseikai Central Hospital, 1-4-17, Mita, Minato-ku, Tokyo, 108-0073 Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Madoiwa
authors.affiliation: Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu, Mie 514-8507 Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
keywords: DIC; Diagnostic criteria; Disseminated intravascular coagulation; Enhanced-fibrinolytic-type DIC; Suppressed-fibrinolytic-type DIC