Disseminated intravascular coagulation in children: diagnosis, management and outcome.

ABSTRACT

A retrospective study of 46 patients with disseminated intravascular coagulation (DIC) is reported. Twenty three patients were neonates with a mean age of 6.7 days (SD = 10) and twenty three patients had a mean age of 2.4 years (SD = 3.3). The ratio of males to females was 11. Thirty-two out of 46 patients (69.6%) had underlying diseases such as congenital abnormalities in cardiovascular and gastrointestinal systems. The diagnosis of DIC was suspected in the critically ill patients who had certain conditions that could trigger DIC. The laboratory findings revealed red blood cell fragmentation 93.4%, thrombocytopenia 95.5%, prolonged coagulogram 71.9% and increased FDP 74%. The management included treatment of underlying diseases, identification and relief of triggering conditions, correction of coagulopathy and supportive care. In terms of infection, appropriate antimicrobial agents were administered. Exchange transfusion was performed in 21 patients and heparin was given to patients with major vessel thrombosis such as renal vein thrombosis. Inspite of the above mentioned managements, the overall case-fatality rate was 52%. Factors related to high case-fatality rate were accompanying fatal diseases, shock, hemorrhage or thrombosis. There were no correlations between fatality rate and age, sex, triggered conditions or exchange transfusion. There is a need to establish an effective treatment that can stop the rapid ongoing process of DIC in order to achieve a better outcome in patients with DIC.