Disseminated intravascular coagulation in acute leukaemias at first diagnosis

Abstract

Haemorrhagic diathesis is the commonest cause of morbidity and mortality in acute leukaemias (AL). It is most commonly due to thrombocytopenia resulting from bone marrow failure. However, in a significant number of cases, disseminated intravascular coagulation (DIC) plays an important part. Previously it was thought that this mechanism was mainly confined to acute promyelocytic leukaemia (APL), but recently it has also been reported to occur in other subtypes of acute leukaemia. We report the results of a study carried out to find the incidence of DIC in various types of AL at the time of first diagnosis and in the absence of other recognisable causes. DIC was observed in 14(13.4%) cases out of 104 cases of AL studied. Nine out of 49(18.4%) cases of AML and 5 out of 55(9.1%) cases of acute lymphoblastic leukaemia (ALL) showed coagulation abnormalities consistent with DIC. Out of the 9 cases of AML showing DIC, 63 (66.67%) belonged to APL (FAB ME) subtype. Three (60%) out of 5 cases of ALL with DIC had T‐cell immunophenotype. The results indicate that DIC may also occur in types of AL other than APL, particularly in T‐ALL, and should be looked for.

Recombinant human thrombomodulin in the treatment of acute myeloid leukemia patients complicated by disseminated intravascular coagulation: retrospective analysis of outcomes between patients treated with heparin and recombinant human thrombomodulin therapy

“…According to the JMHW criteria, 45% of non-APL AML patients developed DIC during induction therapy, which was consistent with previous findings [3][4][5][6][7][8].…”

“…DIC has often been associated with bleeding manifestations in AML cases, especially in APL cases [3][4][5][6][7][8]. DIC also occurs as a devastating complication in patients with other types of AML.…”

“…Although DIC also occurs as a devastating complication in patients with other types of acute myeloid leukemia (AML), it develops less frequently [3][4][5][6][7][8]. The release of procoagulant materials or enzymes from blasts or the fibrinolytic activity of leukemic cells themselves has been implicated in DIC [5,9,10].…”

A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D‐dimer levels are a sensitive indicator of acute promyelocytic leukemia

“…Furthermore, the presence of increased schistocytes (≥1%) is neither a sensitive nor specific marker for the diagnosis of DIC. While others have previously noted, and we too identified an association of DIC with APL , that markedly elevated D‐dimer concentrations ≥19 000 ng/mL FEU would be a highly sensitive test for APL vs . other acute leukemias has not been described previously, but is perhaps not surprising.…”

Disseminated intravascular coagulation at diagnosis is a strong predictor for thrombosis in acute myeloid leukemia

“…10,[22][23][24] In previously published reports, the following risk factors for developing DIC were identified: high levels of C-reactive protein, high leukocyte counts, negative expressions of CD-13 and HLA-DR, and cytogenetics with a normal karyotype or 11q23 abnormality. 22 None of these previous studies reported on thrombosis or bleeding complications in relation to DIC.…”