Seven patients with clinical and laboratory features of disseminated intravascular coagulation were presented and analyzed. With two cases of septicemia as the leading cause, preclampsia, snake bite (Agkistroden halys), anaphylactic shock of unknown etiology, acute promyelocytic leukemia, and lymphoreticular malignancy were underlying in one case each.
Petechia, purpura and bleeding from the sites of venipuncture were observed in all cases, hematuria and vaginal bleeding being next in frequency. All cases disclosed mild to moderate anemia with fragmented red cells in five cases suggesting associated microangiopathic hemolytic anemia. Significant thrombocytopenia, prolonged prothrombin time and thrombin time, and depress plasma fibrinogen level were almost always present, as well as positive F.D.P. tests. But the results of euglobulin lysis time were variable.
Treated with heparin, two patients were improved promptly, another two showed partial improvement; but the responses to heparin therapy were indeterminate in the remaining three cases who had rapidly fatal course within 24 hours. Improvement was manifested by the cessation of bleeding tendency within one to four days, and the restoration of prothrombin time, fibrinogen level and platelet counts toward normal within one to two days after heparin therapy. In three autopsied cases, fibrin thrombi were found in the microvasculature of kidney, spleen, and the lung.
Ultimate prognosis in patients with disseminated intravascular coagulation seems to be dependent upon the underlying diseases as well the appropriate supportive therapy including heparin.
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