Blood coagulation, fibrinolytic and unspecific proteolytic parameters were investigated in 34 patients with acute myeloid leukemia. An increased activity of the coagulation system, documented by elevated thrombin-antithrombin III-complex (TAT) plasma levels, was found in 91% of the patients; 50% had increased elastase plasma levels. Hyperfibrinolysis, as shown by elevated fibrin split-product D-Dimer plasma levels, was detected in 91% of AML patients. Activation of these enzyme systems was not associated with relevant defects in blood coagulation or fibrinolysis in the majority of the patients investigated. In selected cases of promyelocytic M3 and monoblastic M5 leukemia, however, hypofibrinogenemia and alpha 2-plasmininhibitor deficiency was found, most likely due to depletion of these proteins in the course of disseminated intravascular coagulation and secondary hyperfibrinolysis. Significant correlations were calculated between TAT and fibrinogen (r = -0.57, P less than 0.005), TAT and D-Dimer (r = 0.89, P less than 0.0005), and D-Dimer and alpha 2-plasmininhibitor (r = -0.77, P less than 0.0005) levels. Indications of a pathogenetic importance of primary hyperfibrinolysis or unspecific proteolysis for hypofibrinogenemia and alpha 2-PI deficiency were not found.
Chronic venous insufficiency is a widespread disease that can often lead to venous leg ulcers. Recent studies report that certain clotting abnormalities, such as anticardiolipin antibodies, are associated with leg ulcers. Although lupus anticoagulant belongs to the antiphospholipid antibodies, its presence in patients with chronic venous insufficiency has not been reported previously. The purpose of our study was to determine the presence of lupus anticoagulant in chronic venous insufficiency patients at a stage with no leg ulcers, and to follow the clinical outcome. In 37 patients with chronic venous insufficiency and in 54 control patients, lupus anticoagulant was evaluated using the Viper Venom Russell's Diluted Test. Lupus anticoagulant was found significantly more often (p < 0.001) in patients with chronic venous insufficiency than in controls. After 4 years, patients with chronic venous insufficiency with lupus anticoagulant were found to develop a venous leg ulceration more frequently compared to those without (p = 0.01), suggesting that lupus anticoagulant may play an important role in the pathogenesis of chronic venous insufficiency.
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