Co-occurrence of hyperleukocytosis and elevated fibrin–fibrinogen degradation product levels is a risk factor for early intracranial hemorrhage in patients with de novo acute leukemia

Abstract

Early intracranial hemorrhage (eICH) is a potentially fatal complication of acute leukemia. We analyzed risk factors for eICH in patients with de novo acute leukemia. Ninety-one de novo acute leukemia patients at our institution between September 2003 and June 2014 were included. Of the 91 patients, eight (8.8 %) and 83 were included in the eICH and non-eICH groups, respectively. Univariate analysis demonstrated that white blood cell (WBC) count (P = 0.018), fibrin-fibrinogen degradation product (FDP) level (P = 0.0075), co-occurrence of WBC ≥50,000/µl and FDP level >40 µg/ml (P < 0.001), and fever (P = 0.248) were all significant predictors of eICH at the 0.25 level. In a subsequent multivariate analysis involving these parameters, only the combination of hyperleukocytosis and elevated FDP levels was found to be significant at the 0.05 level. A significant difference in the duration of the overall survival (OS) period was detected between patients that did and did not exhibit the combination of hyperleukocytosis and elevated FDP levels (P < 0.001). Co-occurrence of hyperleukocytosis and elevated FDP levels is a significant risk factor for eICH in patients with de novo acute leukemia and has a significant adverse affect on OS.

Analysis of Risk Factors of Coagulation Dysfunction and Hemorrhage in Newly Diagnosed Hyperleukocytic Acute Myeloma Leukemia

“…Hyperleukocytosis has been suggested to be a risk factor for venous thrombosis in a variety of organs [8,[10][11][12][13][14]. Hyperleukocytic hemorrhage was considered to occur due to vascular rupturing caused by leukemic thrombi and/or necrosis of ischemic tissue [15,16].…”

Clinical characteristics and prognostic factors in intracranial hemorrhage patients with hematological diseases

“…The prognostic factors for the 30-day mortality in ICH patients with a hematological disease included age, white blood cell count, AA, ITP, SH, MSH, and a disturbance of consciousness. This may have been because ICH was regarded as secondary to vascular rupturing caused by the leukemia and thrombosis and necrosis of the ischemic tissue [ 31 ]. Moreover, AA and ITP are considered to be benign hematological diseases, and prognosis for ICH patients with AA and ITP is relatively better than that of AL patients with ICH, which may be attributed to AL patients being associated with and being more prone to co-infections, coagulation abnormalities, and elevated white blood cell levels.…”

Leukostasis in Chronic Lymphocytic Leukemia

“…Chest X-ray (CXR) may show the alveolar pattern of infiltrates or can be normal [ 19 ]. It is possible that brain imaging, either CT or magnetic resonance imaging (MRI), might reveal an ischemic area, a CNS mass, or even areas of intracranial hemorrhage secondary to leukemic thrombi or ischemic tissue [ 20 ].…”