Differentiating and Managing TTP vs DIC

Critical Diagnostic Distinctions

In DIC, platelet counts are moderately reduced but rarely as profoundly low as in TTP, with a threshold of <20×10⁹/L, according to the International Society on Thrombosis and Haemostasis 1, 2
Fibrinogen is typically normal in TTP but consumed and low in DIC, with a level of <1.5 g/L indicating replacement, as recommended by the International Society on Thrombosis and Haemostasis 1, 2
DIC occurs in the context of sepsis, trauma, malignancy, or obstetric complications, with multi-organ dysfunction and hepatic involvement, as described by the International Society on Thrombosis and Haemostasis 3, 1

Management of the underlying condition, such as sepsis or malignancy, is the cornerstone of DIC treatment, as recommended by the International Society on Thrombosis and Haemostasis 1, 2, 4
Active bleeding in DIC requires maintaining platelets >50×10⁹/L, with transfusion thresholds based on the International Society on Thrombosis and Haemostasis guidelines 1, 2, 4
Fresh frozen plasma is recommended at 15-30 mL/kg for active bleeding with prolonged PT/aPTT, according to the International Society on Thrombosis and Haemostasis 1, 2, 4
Fibrinogen replacement is indicated if <1.5 g/L despite FFP, with cryoprecipitate or fibrinogen concentrate, as recommended by the International Society on Thrombosis and Haemostasis 1, 2, 4
Heparin is indicated primarily for thrombotic-predominant DIC, with contraindications including active bleeding, platelets <20×10⁹/L, and hyperfibrinolytic DIC, as described by the International Society on Thrombosis and Haemostasis 4
Daily monitoring of CBC, PT/aPTT, fibrinogen, and D-dimer is recommended in acute DIC, with a 30% drop in platelet count indicating potential subclinical DIC progression, according to the International Society on Thrombosis and Haemostasis 1, 2, 5

In DIC, do not transfuse prophylactically based on laboratory values alone without bleeding or high-risk procedures, as recommended by the International Society on Thrombosis and Haemostasis 4, 6
Recognize that normal platelet counts do not exclude DIC in patients with baseline thrombocytosis from malignancy, with decreasing trends indicating potential DIC, according to the International Society on Thrombosis and Haemostasis 1, 2
PT/aPTT may be normal in early or cancer-associated DIC, with the International Society on Thrombosis and Haemostasis recommending against relying solely on these tests 1, 2