:

Practical-Haemostasis.com



A Practical Guide to Haemostasis

ISTH DIC Scoring Algorithm:
Modifications for use in Pregnancy

Introduction:

DIC is a recognised cause of maternal mortality and a modification of the ISTH DIC Scoring algorithm was developed for use in pregnancy.  The modifications are necessary due to the changes in haemostasis that occur in normal pregnancy. The use of three components of the ISTH DIC score - Platelet count, Fibrinogen and differences in PT [compared to a normal laboratory control] allowed the development of an algorithm with a sensitivity of 88% and a specificity of 96% for the diagnosis of DIC. D-dimers were excluded as the levels rise in pregnancy and substantially after 20 weeks in pregnancy.

The ISTH DIC Score - Pregnancy:


Select Criteria:

Platelet Count
<50 x 109/L 1 Point
50 - 100 x 109/L 2 Points
100 - 185 x 109/L 1 Point
>185 x 109/L 0 Points
Prothrombin Time [PT] Difference [s]1
<0.5 0 Points
0.5 - 1.0 5 Points
1.0 - 1.5 12 Points
>1.5 25 Points
Fibrinogen [Clauss] Level
≤3.0 g/L 25 Points
3.0 - 4.0 g/L 6 Points
4.0 - 4.5 g/L 1 Point
≥4.5 g/L 0 Points

1Defined as the difference between the result of the patient and that of the laboratory normal control.

Score

[Max score 52]

Interpretation of Score
≥26 Sensitivity of 88% and a specificity of 96% for the diagnosis of DIC



Click HERE to Reset

Navigation

Screening Tests
Introduction & Bleeding Questionnaires
Prothrombin Time [PT]
Activated Partial Thromboplastin Time [APTT]
Thrombin Time [TT]
Fibrinogen Assays
Summary
Factor & Inhibitor Assays
Factor Assays
Introduction
1-Stage PT-based Factor Assays
1-Stage APTT-based Factor Assays
1-Stage RVV-based Factor X Assay
2-Stage Factor VIII Assay
Chromogenic FVIII and FIX Assays
Factor XIII Assays
 Monitoring Concentrates and non-factor Therapies
 Inhibitor Assays
Introduction
Inhibitor Screening Tests
Bethesda Assay
Nijmegen modification
VWF Inhibitor Assays
Von Willebrand Factor [VWF] Assays
Introduction
Immunological Assays
FVIII Binding Assay
VWF Collagen Binding Assay
VWF Ristocetin Cofactor Assay
VWF Epitope-Specific Assays
RIPA Assay
VWF Multimer Analysis
VWF Propeptide [VWFpp] Assay
VWF Inhibitor Assays
Platelet Function Testing
Introduction
Light Transmission Aggregometry [LTA]
Impedance Platelet Aggregometry
PFA-100/200
VerifyNow Assay
Global Thrombosis Test
Platelet Nucleotide Assays
Flow Cytometry
Platelet Procoagulant Assays
Thrombophilia Testing
Thrombophilia Testing - Introduction
 Antithrombin Assays
 Protein C Assays
 Protein S Assays
 APCr Assays
 Protein C Global Assay
 Homocysteine
 Antiphospholipid Assays
 Introduction
Dilute Russell Viper Venom Time [dRVVT]
Kaolin Clotting Time [KCT]
Silica Clotting Time [SCT]
Taipan Venom Time
Taipan:Ecarin Ratio
Textarin:Ecarin Ratio
Dilute Thromboplastin Inhibition Test [DTI]
Anticardiolipin & Anti-β2 GPI Assays
Fibrinolytic Assays
Introduction
 D-Dimer Assays
 FDP Assays
 Euglobulin Clot Lysis Time [ECLT]
 Alpha2-PI Assays
 Plasminogen Assays
 PAI-1 Assays
 t-PA Assays
 TAFI Assays
 u-PA Assays
 Venous Occlusion Test
 Global Assays of Fibrinolysis
 GFC Assay
 CloFAL Assay
 OHP Assay
 CIP Assay
Genetic Tests
Introduction
 Bayesian Risk Analysis
 Pascal's Triangle
 Linkage Analysis
 Mutational Analysis
 Hardy Weinberg Principle
 Prothrombin F2 G20201A Mutation
 Factor V Leiden Mutation
Miscellaneous Tests
Activated Clotting Time [ACT]
 Anti-Xa Assays
 ADAMTS13 Assays
 HIT and HIT Assays
 Ecarin Clotting Time [ECT]
 Protamine Sulphate Neutralisation Test
 Prothrombinase-induced Clotting Test
 Reptilase Time
Stypven Time
ISI and INR
 Bleeding Time [BT]
Heparin Cofactor II [HCII] Assays
Prothrombin F1+2 Assays
Global Tests of Haemostasis
Introduction to Global Assays
 ETP Assays
 TEG and ROTEM Analyses
Global Thrombosis Test
ReoRox G2 Assay
Global Assays of Fibrinolysis
 GFC Assay
 CloFAL Assay
 OHP Assay
 CIP Assay
Quality Assurance
An introduction to Quality Assurance in Haemostasis
 Pre-Analytical Variables
Risk Assessment Algorithms
Risk Assessment Algorithms: Introduction
 Atrial Fibrillation and Ischaemic Stroke
 Atrial Fibrillation and the Risk of Bleeding
Anti-Phospholipid Syndrome [APS]
Bleeding Assessment
DIC Assessment
Heparin-induced Thrombocytopaenia [HIT]
Post-Thrombotic Syndrome
Thrombotic Microangiopathies [TMAs]
Upper Extremity Thromboses
VTED Risk In Hospitalised Patients
VTED - Diagnosis
VTED - Assessing Bleeding Risk
VTED - Risk of Recurrence
VTED and Cancer
Useful Information
Paediatric Reference Ranges
 Haemostatic Drugs
 DOACs and Laboratory Tests
 Snake Venoms in Haemostasis
Vitamin K & Haemostasis

Home Page

HOME PAGE

Data Interpretation App

EMBOLUS - THE APP

Miscellaneous

CONTACT US
SITE MAP
PRIVACY POLICY

Comments

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

The user of Practical-Haemostasis.com, assumes sole responsibility for any decisions made or actions taken based on the information contained herein.

LINKS & References

1. Erez O, Novack L, et al. DIC score in pregnant women--a population based modification of the International Society on Thrombosis and Hemostasis score. PloS one. 2014; 9: e93240.

2. Papageorgiou C, Jourdi G, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. 2018: 1076029618806424.

3. Rabinovich A, Abdul-Kadir R, et al. DIC in obstetrics: Diagnostic score, highlights in management, and international registry-communication from the DIC and Women's Health SSCs of the International Society of Thrombosis and Haemostasis. J Thromb Haemost. 2019; 17: 1562-6.

4. Click HERE to access the RCOG guideline on Thromboembolic Disease in Pregnancy and the Puerperium.

Site Design:    Sang Medicine Ltd
Updated:         03-Feb-2023