Disseminated Intravascular Coagulation in Hematologic Malignancies

Abstract

Disseminated intravascular coagulation (DIC) significantly contributes to the bleeding and thrombotic complications in patients with hematologic malignancies. As shown in other cancer settings, an underlying condition of activation of the coagulation system leading to a prothrombotic state of chronic or subclinical DIC is detectable. A variety of disease- or treatment-related factors may affect this condition, enhancing the risk of thrombosis or of bleeding and further triggering mechanisms of DIC in this setting. An overt DIC is diagnosed in approximately 15% of patients with acute leukemia, and bleeding manifestations prevail over thrombosis, with the highest and most harmful clinical impact in acute promyelocytic leukemia (APL). Pathogenic mechanisms include a series of intrinsic properties of malignant cells, able to directly activate the coagulation system or to stimulate prothrombotic effects by the host cells. Moreover, chemotherapy or concomitant infections play an important concurrent role. In this review the coagulation abnormalities, clinical manifestations, and the presently known pathophysiologic mechanisms of DIC in patients with hematologic malignancies are discussed, focusing on the most extensively studied condition of APL. Current approaches and open issues for the management and treatment of these patients are also reviewed.

Ulcérations buccales révélatrices d’une leucémie aiguë myéloïde de type 4

“…Enfin, les gingivorragies sont un signe commun chez les patients atteints de leucémie [10], soit suite à la thrombopénie, soit suite à une CIVD. La CIVD diagnostiquée chez environ 15 % des malades atteints de leucémie aiguë contribue de manière significative à l'hémorragie et aux complications thrombotiques chez les patients ayant des tumeurs malignes hématologiques [11]. Elle se caractérise par la formation de microthrombus dans les vaisseaux sanguins à l'origine d'une consommation excessive des facteurs de la coagulation.…”

Safety of plasma‐derived protein C for treating disseminated intravascular coagulation in adult patients with active cancer

“…Less is known regarding the correlation between active cancer and coagulation consumption leading to DIC in patients without signs or symptom of sepsis [10][11][12][13]. As the presenting condition, DIC occurs in 2-5% of patients suffering from solid neoplasm [10].…”

“…Many factors can contribute to coagulopathy in tumors. Cancer cells express different procoagulant molecules as well as fibrinolytic proteins [10][11][12][13], and chemotherapy may enhance the risk of thrombosis due to its damaging effect on the endothelium [11]. Some clinical differences exist between the coagulopathy that occurs in sepsis in comparison to the one occurring in cancer.…”

“…In general, a less severe picture occurs in cancer patients where chronic activation of coagulation can proceed with few clinical events. This process usually leads to exhaustion of platelets and coagulation factors, thus making bleeding (e.g., at the site of the tumour) the first clinical symptom of DIC, while in other cases, cancerrelated coagulopathy occurs in the form of thrombotic microangiopathies [10][11][12][13]. In cancer-related DIC, conventional treatment is related to high mortality also due to the difficulty in properly treating the underlying neoplasm [10].…”

“…In fact, this complication, although rare, is extremely severe and difficult to treat properly [10,13,17]. Based on the notion that depression of the PC system may contribute significantly to the beginning of DIC in cancer patients, supplementation of PC may be of benefit [1,2,10,12].…”