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DIC Screen

DIC, DICSC, Consumptive Coagulopathy Screen, Screen for Disseminated Intravascular Coagulation

Test Codes

Antrim #26305, EPIC: LAB5176

Department

Coagulation

Instructions

• The DIC Screen includes:
  • Fibrinogen
  • Quantitative D Dimer
• Specimens with hematocrit values greater than 55% must have anticoagulant adjusted. Specimens must be re-collected using a specified whole blood to sodium citrate ratio. Contact the performing Laboratory for specific instructions.

Specimen Collection Criteria

Collect: One Light Blue-top 3.2% Sodium Citrate tube.

TUBE MUST BE FULL.

Physician Office/Draw Specimen Preparation

Maintain whole blood specimen at room temperature (20-26°C or 68-78.8°F) prior to transport. Transport whole blood to the Laboratory within 4 hours of collection. If transport within 4 hours is not possible, the following procedure must be followed for accurate results:

1. Centrifuge the capped tube at 1500 x g for 15 minutes.
2. Transfer plasma with a plastic pipette into a plastic polypropylene centrifuge tube, cap and centrifuge an additional 15 minutes at 1500 x g to obtain platelet poor plasma (PPP) which has a platelet count less than 10 bil/L. Plasma with a platelet count of less than 10 bil/L is critical for accurate results.
3. Immediately remove only the top two-thirds of the PPP and transfer it into a screw cap, 5 ml, 75 x 13 mm, round base, polypropylene tube.  
4. Freeze (-20°C/-4°F or below) the PPP immediately.
5. Transport frozen on DRY ICE. Specimen must remain frozen during transport.  

Preparation for Courier Transport

Transport: Whole blood at room temperature (20-25°C or 68-77°F), or plasma obtained through the process listed above, frozen (-20°C/-4°F or below).

Rejection Criteria

• Glass tubes and 3.8% Sodium Citrate tubes.
• Specimens that are clotted or grossly hemolyzed.
• Inappropriate specimen volume.
• Thawed or partially thawed specimens. 

In-Lab Processing

Whole blood specimens must be processed as follows upon receipt in the Laboratory:

1. Centrifuge the capped tube at 1500 x g for 15 minutes.
2. Transfer plasma with a plastic pipette into a plastic polypropylene centrifuge tube, cap and centrifuge an additional 15 minutes at 1500 x g to obtain platelet poor plasma (PPP) which has a platelet count less than 10 bil/L. Plasma with a platelet count of less than 10 bil/L is critical for accurate results.
3. Immediately remove only the top two-thirds of the PPP and transfer it into a plastic tube.

4. Test or freeze specimen according to lab protocol.

Storage

Specimen Stability for Testing:

Whole Blood

Room Temperature (20-26°C or 68-78.8°F): 4 hours
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): Unacceptable

Platelet Poor Plasma (PPP)

Room Temperature (20-26°C or 68-78.8°F): Unacceptable
Refrigerated (2-8°C or 36-46°F): Unacceptable
Frozen (-20°C/-4°F or below): 30 days. Plasma aliquot must be frozen for transport.

Specimen Storage in Department Prior to Disposal:

Refrigerated (2-8°C or 36-46°F): 7 days*
Room Temperature (20-26°C or 68-78.8°F): 7 days

*NOTE: A new sample is required in order for add-on testing. 

Laboratory

Dearborn Hematology Laboratory
Farmington Hills Hematology/Coagulation Laboratory
Grosse Pointe Hematology/Coagulation Laboratory
Lenox Main Laboratory
Livonia Main Laboratory
Royal Oak Coagulation Laboratory
Trenton Hematology/Coagulation Laboratory
Troy Hematology/Coagulation Laboratory
Wayne Hematology/Coagulation Laboratory

Performed

Sunday – Saturday, 24 hours a day.
STAT results available within 30 minutes of receipt in the Laboratory unless further verification is necessary. 
Routine results available within 4 hours of receipt in the Laboratory.

Reference Range

Fibrinogen: 200-400 mg/dL

D-dimer:
Venous thromboembolism exclusion (DVT/PE): Less than 500 ng/mL F.E.U.

For patients being evaluated for conditions other than DVT/PE: Values <600 ng/mL may be considered normal. The normal range was developed using subjects who were not screened or tested for DVT/PE, and its use should be limited to the evaluation of other appropriate medical conditions (i.e. DIC, liver dysfunction, etc.). Note that this D-Dimer assay is very sensitive and may be positive in a number of conditions with low levels of thrombin generation, including infectious or inflammatory disorders, malignancy, post-operative wound healing, and pregnancy (including post-partum).

Test Methodology

Fibrinogen: Clauss Method (IL ACL-TOP Series).
D-Dimer: Immunoturbidimetric Assay (IL ACL-TOP Series).

Interpretation

Fibrinogen is an abundant plasma protein, which, after a cascade of enzymatic events in the coagulative process, is cleaved to form fibrin clot. Plasma fibrinogen is decreased in direct proportion to the amount of coagulative activity. D-dimers are the end product of fibrin clot breakdown by plasmin. The combination of an elevated d-dimer and decreased fibrinogen is confirmation of the process of fibrin clot formation and breakdown.

Clinical Utility

• The D-Dimer Assay aids in the diagnosis of the syndrome of intravascular coagulation and fibrinolysis, also known as DIC. However, there are many other conditions that can cause elevated D-Dimer levels (see Reference Range comment above).
• The Fibrinogen Assay also aids in the diagnosis of the syndrome of intravascular coagulation and fibrinolysis, also known as DIC. However, low fibrinogen levels can also be seen in congenital hypofibrinogenemia, dysfibrinogenemia, or afibrinogenemia. Levels may also decrease after severe blood loss, liver disease, renal disease, or thrombolytic therapy.

CPT Codes

85379, 85384.

Contacts

Last Updated

3/30/2023