Fulminant Meningococcemia and Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DIC) is of major pathogenic significance in cases of fulminant meningococcemia rapidly leading to death. This syndrome can be clinically detected with a simple and readily available battery of coagulation tests: the platelet count, prothrombin time, and activated partial thromboplastin time. These tests are sufficiently sensitive to detect the earliest phases of DIC and provide a rational means for selecting patients requiring anticoagulant therapy. Simultaneous abnormalities in all three clotting tests in a patient with meningococcal infection may be regarded as suggestive evidence of DIC. Three patients with evidence of intravascular coagulation were successfully treated with heparin sodium and dextran 70 (molecular weight, 70,000). The course of treatment of these patients supports conclusions regarding the usefulness of these screening tests and the possibility of reversing this clotting disturbance with appropriate therapy.