Assessment of Coagulation Disorders in Patients with Acute Leukemia Before and After Cytostatic Treatment

Abstract

Coagulation disorders are often the reason for fatal bleeding in acute promyelocytic leukemia. Their occurrence as well as pathogenesis and prognostic significance in other subtypes of acute myelogenous leukemia and acute lymphoblastic leukemia is less known. Tests were carried out in 70 patients including 49 with AML and 21 with ALL. In all patients thrombin-antithrombin complexes (TAT), D-dimer (DD) and plasmin-antiplasmin complexes (PAP), antithrombin III activity, fibrinogen/fibrin degradation products, APTT and PT were determined. The tests were performed on diagnosis and after cytostatic treatment. The level of TAT, DD and PAP was elevated in 83% of the patients on diagnosis and in 90% after treatment. The highest values were observed in AML M3 patients. Among leukemic patients with normal levels of TAT, DD and PAP at diagnosis, cytostatic treatment had a negligible effect on the level of these markers. During remission the levels of these markers returned to the normal values while in patients without remission they were either elevated or returned to normal values. No correlation between the levels of activation markers and remission rate was reported. DIC was diagnosed in 13 patients including three after chemotherapy. The DIC was acute or subacute in AML and chronic in ALL patients. In the majority of acute leukemia patients there were already changes on diagnosis indicating coagulation activation. Except for AML M3, these usually had a subclinical course. The TAT, DD and PAP tests are not reliable markers of remission in acute leukemias.

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].…”

The Influence of Low Molecular Weight Heparin on the Intravascular Activation of the Coagulation System in Patients With Acute Leukemia During Induction Chemotherapy--Report of a Prospective Randomized Study

“…Coagulation disorders are already present in the majority of patients with AL at the time of diagnosis [1]. Most commonly they appear in laboratory tests and correspond with chronic activation of the coagulation system, manifested in the elevation of such activation markers as F1 þ 2, TAT, DD and PAP [1,12].…”

“…Coagulation disorders can also occur in other acute myelogenous leukemia (AML) subtypes and in patients with acute lymphoblastic leukemia (ALL). In our previous study we have showed that in the majority of patients with acute leukemia (AL) changes indicating chronic activation of coagulation system are already present at the time of diagnosis [1]. Additionally, these changes can be enhanced by chemotherapy.…”