**2. Disseminated intravascular coagulation (DIC) and clinical use of coagulation biomarkers**

The occurrence of DIC has been the definitive trigger for the use of coagulation biomarkers in the diagnosis of this disease. DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and, ultimately, the thrombotic occlusion of small- and mid-sized vessels [9–11]. Intravascular coagulation can also compromise the blood supply to organs and peripheral cells, and, in conjunction with hemodynamic and metabolic derangements, may contribute to the failure of multiple organs [12].

as cholesterol deposition [25]. FDP can also induce the adhesion and accumulation of white

Clinical Application of Coagulation Biomarkers http://dx.doi.org/10.5772/intechopen.76589 85

In our facility, FDP and D-dimer are measured by an immunoturbidimetric method using Cs-2000i and Cs-5100 systems (Sysmex Corporation., Hyogo, Japan; **Figure 1**). It takes about

blood cells, which results in damage to the blood vessel endothelium [26].

**Figure 1.** Cs-5100 systems to measure FDP and D-dimer (Sysmex Corporation., Hyogo, Japan).

**Table 1.** Common clinical conditions associated with disseminated intravascular coagulation.

15–20 minutes to measure FDP and D-dimer with this instrument.

Sepsis Trauma

Cancer

Serious tissue injury Head injury Fat embolism

Obstetrical complications Amniotic-fluid embolism Abruption placentae

Vascular disorders

Aortic aneurysm Severe hepatic failure

Immunologic disorders Severe allergic reaction Hemolytic transfusion reaction

Transplant rejection

Myeloproliferative diseases

Solid tumors (e.g., pancreatic carcinoma, prostatic carcinoma)

Giant hemangioma (Kasabach-Merritt syndrome)

Reactions to toxins (e.g., snake venom, drugs and amphetamines)

DIC is present in many clinical conditions (**Table 1**) [12].

Of these clinical conditions, coagulation biomarkers have been especially used in the treatment of sepsis. The clinical criteria for the early diagnosis of DIC have incorporated the use of several coagulation biomarkers such as FDP, D-dimer, PT, and fibrinogen [13–16]. In addition, the two endogenous anticoagulants, antithrombin and protein C, are found decreased in patients with DIC, and are useful in predicting the outcome of such patients, as well as those with sepsis [17, 18]. Furthermore, thrombomodulin, tissue factor pathway inhibitor, Von Willebrand factor and Adamts 13 are also useful in clinical situations [19, 20].

Of these coagulation biomarkers, we focused on the use of FDP and D-dimer in several clinical conditions. D-dimer is a specific protein fiber degradation product of cross-linked fibrin in response to hydrolysis by fibrinolytic enzymes [21, 22]. When the thrombus degrades, D-dimer may be released into the circulatory system [23]. In normal blood, the level of D-dimer is low, but once thrombosis occurs, the D-dimer level rises [24]. FDP is the degradation product of fibrous protein. In normal blood, the level of FDP is also low; however, the FDP level also increases when fibrinolysis occurs. FDP is a mitogen for many cell types, promoting the proliferation of endothelial cells, smooth muscle cells, and fibroblasts, as well


**Table 1.** Common clinical conditions associated with disseminated intravascular coagulation.

There is a variety of coagulation biomarkers used in real clinical situation. Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen has been used to test the coagulation function from long ago in hematologic disorder, liver disease, disseminated intravascular coagulation (DIC) and to monitor the use of anticoagulation drugs. Owing to the recent progress in measuring method, the more minute coagulation biomarkers can be measured and divided into coagulation systems and fibrinolytic systems. Each example is thrombinantithrombin complex (TAT), soluble fibrin (SF) and soluble fibrin monomer complex (SFMC) in coagulation systems, and Fibrin degradation product (FDP) and D-dimer in fibrinolytic systems. They are relatively new coagulation biomarkers and the characteristics of them are to be rapidly elevated in acute phase. In clinical situation, they are practically used to detect the venous thromboembolism [4–6]. Besides, FDP and D-dimer are more studied, and the clinical applications of these coagulation biomarkers are ranging from diagnosing [7] to the

In this chapter, we present information on the successful use of FDP, D-dimer and fibrinogen in clinical practice. Finally, we demonstrate the prospects of the clinical application of coagu-

The occurrence of DIC has been the definitive trigger for the use of coagulation biomarkers in the diagnosis of this disease. DIC is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and, ultimately, the thrombotic occlusion of small- and mid-sized vessels [9–11]. Intravascular coagulation can also compromise the blood supply to organs and peripheral cells, and, in conjunction with hemodynamic

Of these clinical conditions, coagulation biomarkers have been especially used in the treatment of sepsis. The clinical criteria for the early diagnosis of DIC have incorporated the use of several coagulation biomarkers such as FDP, D-dimer, PT, and fibrinogen [13–16]. In addition, the two endogenous anticoagulants, antithrombin and protein C, are found decreased in patients with DIC, and are useful in predicting the outcome of such patients, as well as those with sepsis [17, 18]. Furthermore, thrombomodulin, tissue factor pathway inhibitor,

Of these coagulation biomarkers, we focused on the use of FDP and D-dimer in several clinical conditions. D-dimer is a specific protein fiber degradation product of cross-linked fibrin in response to hydrolysis by fibrinolytic enzymes [21, 22]. When the thrombus degrades, D-dimer may be released into the circulatory system [23]. In normal blood, the level of D-dimer is low, but once thrombosis occurs, the D-dimer level rises [24]. FDP is the degradation product of fibrous protein. In normal blood, the level of FDP is also low; however, the FDP level also increases when fibrinolysis occurs. FDP is a mitogen for many cell types, promoting the proliferation of endothelial cells, smooth muscle cells, and fibroblasts, as well

**2. Disseminated intravascular coagulation (DIC) and clinical use of** 

and metabolic derangements, may contribute to the failure of multiple organs [12].

Von Willebrand factor and Adamts 13 are also useful in clinical situations [19, 20].

DIC is present in many clinical conditions (**Table 1**) [12].

treatment [8].

lation biomarkers.

**coagulation biomarkers**

84 Biomarker - Indicator of Abnormal Physiological Process

as cholesterol deposition [25]. FDP can also induce the adhesion and accumulation of white blood cells, which results in damage to the blood vessel endothelium [26].

In our facility, FDP and D-dimer are measured by an immunoturbidimetric method using Cs-2000i and Cs-5100 systems (Sysmex Corporation., Hyogo, Japan; **Figure 1**). It takes about 15–20 minutes to measure FDP and D-dimer with this instrument.

**Figure 1.** Cs-5100 systems to measure FDP and D-dimer (Sysmex Corporation., Hyogo, Japan).
