Coagulation patterns of disseminated intravascular coagulation in acute promyelocytic leukemia

Abstract

Coagulation patterns of 19 newly-diagnosed acute promyelocytic leukemia (APL) patients with disseminated intravascular coagulation (DIC) at presentation were studied. Seventeen patients had hemorrhagic complications, of which four were fatal. Fatal hemorrhages were related with lower fibrinogen level and lower platelet count. DIC of the APL patients without infection was characterized by low fibrinogen and normal antithrombin III (ATIII) level. Thrombin-ATIII complex level was elevated in all patients examined. Patients with infection had higher fibrinogen levels than those without infection and some patients had reduced ATIII level. Ten remission inductions were tried with multidrug chemotherapy and seven with all-trans retinoic acid (ATRA). Complete remission was achieved in seven of ten inductions with chemotherapy and in all seven inductions with ATRA. Two patients treated with chemotherapy had fatal hemorrhage after starting therapy but none treated with ATRA.

The Role of the Plasminogen Activation System in Cancer

“…322 Measurement of tumor necrosis fac tor alpha (TNFa) has been used as a marker in DIC. 323 Severe DIC, with consumption of platelets and clotting factors and bleeding is rare and is most commonly asso ciated with acute promyelocytic leukemia, 324 acute myeloid leukemia (AML), 325 acute lymphoblastic leuke mia (ALL), 326 and adenocarcinomas. DIC can be exacer bated during chemotherapy, particularly in acute myeloid leukemia, as lysis of the cells leads to further release of procoagulant activity.…”

The Role of Platelets in Cancer-Related Bleeding Risk: A Systematic Review

“…[135][136][137][138][139][140][141][142][143][144] There were 3 posthoc studies on data from randomized controlled trials, 104,117,120 2 case series 111,112 and 47 cohort studies, among which data were collected prospectively in 24 96,97,99,105-110,113,115,116,118,123,126,127 129-131,135,136,140,142,144 and obtained from medical records in 23. 2, 94,95,98,100-103,114,119,121,122,124,125,128,132-134,137-139 141,143 Platelet count only was reported in 40 studies, 2, 94,95,97,98,[100][101][102][103][104][105]107,114,[116][117][118][119][120][121][122][124][125][126][127][128][129][130][131][132][133][134]…”

“…98 Among studies rating fair, 10 studies reported associations between platelet counts and bleeding. 94,100,103,106,107,118,119,122 Lower median platelet counts in bleeding versus nonbleeding leukemia patients were reported by Higuchi et al (median: 13 Â 10 9 /L vs. 23 Â 10 9 /L) 103 and Kazianka et al (median: 117 Â 10 9 /L vs. 137 Â 10 9 /L). 106 Two studies reported increased bleeding prevalence with platelet counts 10 Â 10 9 /L versus >10 Â 10 9 /L (Aderka et al's study: 51 vs. 20% 94 ; Fu et al's study: 37 vs. 9% 100 ).…”

Guidelines on the diagnosis and treatment for acute promyelocytic leukemia: Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular Guidelines Project: Associação Médica Brasileira - 2013

“…About 60 to 80% of patients have some clotting disorder at diagnosis. Currently, mortality rates secondary to thrombohemorrhagic events during induction occur in around 5 to 7% of patients eligible for clinical studies (B) 14., 19., 20.…”