Disseminated Intravascular Coagulation at Diagnosis in Acute Myeloblastic Leukaemia

Abstract

Background: Disseminated Intravascular Coagulation (DIC) is a life threatening complication frequently observed in acute leukemia. Among the morphological varieties of Acute Myeloid Leukaemia (AML), Acute Promyelocytic Leukaemia (APL) is well established to cause DIC. But there have been reports noted that abnormal DIC parameters also commonly observed in the patients with non-APL AML. This study evaluated the DIC parameters & DIC score according to International Society of Thrombosis and Haemostasis (ISTH) in newly diagnosed non-APL AML patients. Materials and Methods: This cross-sectional observational study was conducted in the Department of Haematology, BSMMU, Dhaka, Bangladesh. 48 newly diagnosed non-APL AML patients were enrolled. Platelets count was measured by auto analyzer (Sysmax XT 2000i/Pentra ABX-120DX) as well as checked manually. Prothrombin time, fibrinogen, D-Dimer were measured using STAGO Coagulation analyzer. The ISTH-DIC scoring system was used to calculate DIC score. The statistical analysis was carried out using the Statistical Package for Social Sciences version 24.0 for Windows. Chi-Square test & Fisher exact test was used for categorical variables. Unpaired t-test was used to compare mean between groups. For all statistical tests, p-value less than 0.05 was considered as statistically significant. Results: By analyzing 48 newly diagnosed patients with non-APL AML, found that DIC developed in 14.6% patients at presentation. Among the DIC parameters, PT and D-dimer were significantly higher in patients presented with DIC. Patients with DIC exhibit lower expression of CD117, CD34, HLA-DR and statistically significant association with negative expression of HLA-DR (p-value 0.034

Disseminated intravascular coagulation in a cohort of adult acute leukemia patients: a single center experience

“…Accordingly, we can conclude that many of our cases had advanced DIC. Chowdhury et al [20] found that only PT and D-Di were significantly higher in overt DIC. On the other hand, Aggarwal et al [25] reported that only platelets and D-Di levels were significantly different between the overt DIC and non-DIC patients.…”

“…In two separate studies from Serbia, DIC was found in 42% of AML; in the other one done over APL patients, it was observed in 84% [16,17]. Other studies reported variable rates of overt-DIC in non-APL AMLs ranging from 6.4% to 25.2% [18][19][20]. These diverse rates are attributed mostly to the differences in the enrolment criteria and different scoring systems used for diagnosing overt DIC by different studies [5].…”

Early hemostatic derangements in patients with de novo acute leukemia: A single center experience

“…The similarities and disparities in these results may be explained by the differences in the characteristics of the studied cohorts including leukemic subtype, age, and gender. 18,19 Nearly one third of the current AL patients had reduced levels of natural coagulation inhibitors; PC in 34.5%, PS in 28.6%, and AT in 26.2% of the patients. The reduction in PC and PS could be attributed to the cytokine release in AL and the systemic inflammation which leads to the down regulation of thrombomodulin and consequently lowering the PC and PS.…”