Haemostatic changes in acute leukaemia at diagnosis and post induction phase of chemotherapy

Abstract EN

Acute Leukaemia is one of the diseases associated frequently with disseminated intravascular coagulation (DIC) , early diagnosis and management of the primary illness will be of great help in decreasing the frequency and the severity of this complication.

The study was conducted to confirm abnormalities of haemostasis and the evidence of disseminated intravascular coagulaton in newly diagnosed patients with acute leukaemia at presenrtation and post chemothaerpy.

Prospectively 40 newly diagnosed acute leukaemic patients were enrolled, 28/40 were with acute myeloid leukaemia , 12/40 acute lymphoblastic leukaemia .

Their age range between 9 to 60 years, 29/40 were females and 11/40 males.Prior to treatment and any supportive care, full clinical evaluation, complete blood cell count and blood film, bone marrow examination, cytochemical stains,liver and renal function tests were done and haemostatic evaluation was performed at time of diagnosis and post induction therapy phase.

The coagulation tests performed were prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen assay and D-dimer reaction.

The Japanese score for diagnosis of disseminated coagulation and fibrinolysis in acute leukaemia was adopted, but has been modified according to what is available of materials.

The laboratory tests results elicited that the most common haemostatic abnormalities are thrombocytopenia 92.5%, positive D-dimer reaction 82.5%, prolonged APTT 42.5%, prolonged PT 30%, prolonged TT 22.5%, reduced fibrinogen 12.5%.

The incidence of DIC was (25%), (70%) of them presented with bleeding tendency, D-dimer reaction was positive in 100% of DIC cases, prolonged PT in 90% of them, reduced fibrinogen in 50%.

After treatment with supportive measures and induction phase of chemotherapy the relative frequency of improvement was in 80% of DIC cases.

The relative frequency of improvement of PT, APTT, TT, bleeding manifestation, D-dimer reaction was 83.3%, 64.6%, 66.6%, 85.7%, 39.4% respectively.

Early diagnosis and management of DIC is important in reducing the mortality and morbidity in acute leukemia by careful clinical evaluation together with the laboratory investigations applying the modified Japanese score .

Thrombocytopenia appears to be the most common haemostatic abnormality ,though it is not specific nor sensitive sign of DIC.

A normal fibrinogen level does not exclude DIC since it is an acute phase reactant but serial follow up assays of fibrinogen concentration may be more informative.