Coagulopathy in Adult Acute Leukemia at Presentation in National Center of Hematology (NCH), Baghdad


Abstract: Background: Malignancy is associated with a hypercoagulable state and a high risk for thrombohemorrhagic complications, clinical complications may range from localized thrombosis more in solid tumors to bleeding of varying degrees of severity because of disseminated intravascular coagulation (D.I.C.) as in acute leukemia. Aim of the study: To search for the real cause of coagulopathy (bleeding or thrombosis) in patients with acute leukemia.Materials and methods: This study was conducted at the NCH between January 2010 and September 2011, 96 patients with acute leukemia where evaluated prospectively for hemostatic abnormality at presentation of which 43 (44.79 %) had acute lymphoblastic leukemia (ALL) and 53 (55.21 %) had acute myeloid leukemia of which 14 (14.58) were cases of Acute Promyelocytic Leukemia (APL).Results: At presentation 2 patients (2.3 %) with AML (M3, APL) subtype had bleeding manifestation (signs of intracranial hemorrhage) and died with in 24-48 hours in spite of urgent supportive managements, (94)patients (97.9 %) had variable abnormalities of coagulation indices which include prothrombin time (P.T.) , partial thromboplastin time (P.T.T.), plasma fibrinogen level and Factor VII levels, ranging from normal indices specially in ALL to slight increment in AML mainly M2 to moderate increase in some patients with M3 (bleeding manifestations noticed to be associated more in few AML M3 this was attributed to the procoagulant activity of cytoplasmic granules in the malignant promyelocytes. Conclusion: From the results obtained in this study which shows that the cause of bleeding is mostly associated with low platelets count , but not due to coagulation factors defects (as only PT was increased in some cases of AML) .Key words: Acute lymphoblastic leukemia, acute myeloid leukemia, acute promyelocytic leukemia.