June 26, 1981

Disseminated Intravascular Coagulation During Rewarming Following Hypothermia

Author Affiliations

From the Division of Hematologic Research, Department of Medicine, The Memorial Hospital, Brown University, Pawtucket, RI.

JAMA. 1981;245(24):2517-2518. doi:10.1001/jama.1981.03310490035022

DISSEMINATED intravascular coagulation (DIC) is a syndrome characterized by hemorrhage, thrombocytopenia, consumption of clotting factors, secondary fibrinolysis with elevated levels of fibrinogen-fibrin degradation products, microangiopathic hemolytic anemia, and fibrin thrombi in blood vessels.1 This syndrome occurs in a variety of clinical conditions and is initiated by the liberation of tissue thromboplastin into the circulation, by vascular endothelial damage, by abnormalities of blood flow, or by all three.1 Disseminated intravascular coagulation has been recognized as a complication of hypothermia in two series of neonatal infants2,3 but has been reported in only one adult patient.4 The present report describes a 13-year-old in whom DIC developed during the rewarming phase of accidental hypothermia.

Methods  The prothrombin time was determined using rabbit brain thromboplastin and the activated partial thromboplastin time was performed with a kaolin-activated reagent (Coag-A-Chek). Fibrinogen levels were measured using a standard thrombin reagent (Data-Fi) and fibrinogen determination