The Japanese Association of Acute Medicine (JAAM) revised its criteria for disseminated intravascular coagulation (DIC). The authors are from multiple institutions in Japan.
Difference from the previous JAAM: removal of fibrinogen (which may have been set too high)
Patient selection: age >= 15 years
Parameters:
(1) number of features of the systemic inflammatory response syndrome (SIRS), out of 4
(2) platelet count in 10^9/L
(3) prothrombin time to upper limit of normal ratio
(4) fibrin and fibrinogen degradation products in mg/L
Criteria for SIRS:
(1) temperature < 36°C or > 38°C
(2) heart rate > 90 beats per minute
(3) respiratory rate > 20 breaths per minute OR PaCO2 < 32 torr
(4) white blood cell count < 4,000 per µL OR > 12,000 per µL OR >= 10% immature (band) forms
ratio of prothrombin time to upper limit of normal =
= (prothrombin time in seconds) / (upper limit of normal for the prothrombin time in seconds)
|
Parameter
|
Finding
|
Points
|
|
SIRS criteria
|
0 or 2
|
0
|
|
|
3 or 4
|
1
|
|
platelet count
|
>= 120 * 10^9/L
|
0
|
|
|
80 to 119.9 * 10^9/L
|
1
|
|
|
30.1 to 50% decrease within 24 hours
|
1
|
|
|
< 80 * 10^9/L
|
3
|
|
|
> 50% decrease within 24 hours
|
3
|
|
prothrombin time ratio
|
< 1.2
|
0
|
|
|
>= 1.2
|
1
|
|
fibrin degradation products
|
< 10 mg/L
|
0
|
|
|
10 to 24.9 mg/L
|
1
|
|
|
>= 25 mg/L
|
3
|
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score >= 4 indicates DIC provided that alternative explanations for the laboratory values have been ruled out.
Limitations:
• The fibrin and fibrinogen degradation products assay needs to be calibrated to match the JAAM measurements.
