Early hemostatic derangements in patients with de novo acute leukemia: A single center experience

Sarah Laith Alnuaimy; Rawand  P. Shamoon

doi:10.15218/zjms.2023.019

Authors

Sarah Laith Alnuaimy Unit of Hematopathology, Nanakali Hemato-oncology Hospital, Erbil, Iraq.
Rawand P. Shamoon Department of Basic Sciences, College of Medicine, Hawler Medical University, Erbil, Iraq.

DOI:

https://doi.org/10.15218/zjms.2023.019

Keywords:

Bleeding, Thrombosis, Hemostatic derangement

Abstract

Background and objective: Bleeding and thrombosis are major causes of morbidity and mortality in patients with acute leukemia (AL); they are attributed to hemostatic derangement and coagulation defects that are associated with leukemia. There is a paucity of information regarding coagulopathy in AL patients in our locality; this study, therefore, was employed to evaluate hemostatic parameters in patients with AL at the time of presentation.

Methods: This prospective cross-sectional study included 84 newly diagnosed patients with AL. The study was carried out at Nanakali hemato-oncology center from September 2021 to May 2022. Patients were assessed for coagulation parameters including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen level (FBG), D-dimer (D-Di), antithrombin (AT), protein C (PC), and protein S (PS).

Results: The median age of the studied patients was 26 years with a male to female ratio of 1.1:1. Acute myeloid leukemia (AML) patients constitutes 51.2% (43 patients), and the remaining 41 (48.8%) patients had acute lymphoblastic leukemia (ALL). PT was significantly prolonged, D-Di was significantly higher and AT, and PC were significantly decreased in AML compared to control groups. Only D-Di level was significantly higher in ALL compared to control groups. Bleeding manifestations were encountered in 40 (47.6%) patients with a higher incidence among the AML group (28 patients, 70%). Thrombosis occurred in 2 (2.4%) patients.

Conclusion: Defects of coagulation were common in AL. Hemostatic derangement and bleeding at the time of presentation were more noticeable in patients with AML.

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References

Okikiolu J, Dillon R, Raj K. Acute leukaemia. Medicine. 2021; 49(5):274–81. https://doi.org/10.1016/j.mpmed.2021.02.004.

Rose-Inman H, Kuehl D. Acuteleukemia. Hematol Oncol Clin North Am. 2017; 31(6):1011–28. https://doi.org/10.1016/j.hoc.2017.08.006.

Hussain AMA, Lafta RK. Cancer trends in Iraq 2000–2016. Oman Med J 2021;36(1):e219. https://doi.org/10.5001%2Fomj.2021.18.

Cate H, Leader A.Management of disseminated intravascular coagulation in acute leukemias. Hamostaseologie. 2021; 41(2):120–6. https://doi.org/10.1055/a-1393-8302.

Kwaan HC, Weiss I, Tallman MS. The role of abnormal hemostasis and fibrinolysis in morbidity and mortality of acute promyelocytic leukemia. Semin Thromb Hemost. 2019; 45(06):612–21. https://doi.org/10.1055/s-0039-1693478.

Lad D, Jain A, Varma S. Complications and management of coagulation disorders in leukemia patients. Blood Lymphat Cancer. 2017; 7:61–72. https://doi.org/10.2147/BLCTT.S125121.

Ismail MM, Hamed GM. Activity levels of natural anticoagulant proteins in childhood acute lymphoblastic leukemia: relation to thromboembolic complications and treatment. Blood Coagul Fibrinolysis. 2017; 28(1):1–7. https://doi.org/10.1097/MBC.0000000000000521

Chu T, Wang H, Lv X, Qi J, Tang Y, Fan Y, et al. Investigation of fibrinogen in early bleeding of patients with newly diagnosed acute promyelocytic leukemia. Platelets. 2021; 32(5): 677–83. https://doi.org/10.1080/09537104.2020. 1799969.

Shahmarvand N, Oak JS, Cascio MJ, Alcasid M, Goodman E, Medeiros BC, et al. A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D-dimer levels are a sensitive indicator of acute promyelocytic leukemia. Int J Lab Hematol. 2017; 39(4):375–83. https://doi.org/10.1111/ijlh.12636.

Tawfiq S, Yassin A, AlGetta H, Hassan K. Acute myeloblastic leukemia: important clinical and epidemiological facts from Hiwahospital in Sulaimaniyah, Iraq. Iraqi Journal of Hematology. 2019; 8:69. https://doi.org/10.4103/ijh.ijh_11_19.

Abuhelwa Z, Shaer QA, Taha S, Ayoub K, Amer R. Characteristics of de novo acute myeloid leukemia patients in Palestine: experience of An-Najah national university hospital. Asian Pac J Cancer Prev. 2017; 18(9):2459–64. https://doi.org/10.22034/APJCP.2017.18.9.2459.

Karim ZA, Khidhir KG, Ahmed RA, Hassan HA, Karim DO. Leukemia study in Sulaymaniyah province, Kurdistan, Iraq. Chin Med J (Engl). 2016; 129(2):244–5. https://doi.org/10.4103%2F0366-6999.173551.

Edgren G, Liang L, Adami HO, Chang ET. Enigmatic sex disparities in cancer incidence. Eur J Epidemiol. 2012; 27(3):187–96. https://doi.org/10.1007/s10654-011-9647-5.

Gómez-Almaguer D, Marcos-Ramírez ER, Montaño-Figueroa EH, Ruiz-Argüelles GJ, Best-Aguilera CR, López-Sánchez MDC, et al. Acuteleukemia characteristics are different around the world: the Mexican perspective. Clin Lymphoma Myeloma Leuk. 2017; 17(1):46–51. https://doi.org/10.1016/j.clml.2016.09.003.

Mjali A, Al-Shammari HHJ, Abbas NT, Azeez ZD, Abbas SK. Leukemia epidemiology in Karbala province of Iraq. Asian Pacific Journal of Cancer Care. 2019; 4(4):135–9. https://doi.org/10.31557/apjcc.2019.4.4.135-139.

Jalal SD, Al-Allawi NAS, Al Doski AAS. Immunophenotypic aberrancies in acute lymphoblastic leukemia from 282 Iraqi patients. Int J Lab Hematol. 2017; 39(6):625–32. https://doi.org/10.1111/ijlh.12716.

Favaloro EJ. Laboratory testing in disseminated intravascular coagulation. Semin Thromb Hemost. 2010; 36(4):458–67. https://doi.org/ 10.1055/s-0030-1254055.

Hu W, Wang X, Yang R. Evaluation of D-dimer and lactate dehydrogenaseplasma levels in patients with relapsed acute leukemia. Oncol Lett 2016; 12(1):591–6. https://doi.org/10.3892/ol.2016.4657.

Chowdhury MU, Begum M, Khan MR, Kabir AL, Islam S, Layla KN, et al. Disseminated intravascular coagulation at diagnosis in acute myeloblastic leukaemia. J Biosci Med. 2021; 9(10):124–34. https://doi.org/10.4236/jbm.2021. 910011.

Choudhry A, DeLoughery TG. Bleeding and thrombosis in acute promyelocytic leukemia. Am J Hematol. 2012; 87(6):596–603. https://doi.org/10.1002/ajh.23158.

Franchini M, Di Minno MND, Coppola A. Disseminated intravascular coagulation in hematologic malignancies. Semin Thromb Hemost. 2010; 36(4):388–403. https://doi.org/10.1055/s-0032-1331154.

Lee HJ, Park HJ, Kim HW, Park SG. Comparison of laboratory characteristics between acute promyelocytic leukemia and other subtypes of acute myeloid leukemia with disseminated intravascular coagulation. Blood Res. 2013; 48(4):250–3. https://doi.org/10.5045/br.2013.48. 4.250.

Shalal HH, Mahmood NS, Alchalabi MAQ. Clinical, hematological, and laboratory presentation of acute lymphoblastic leukemia of children in Diyala province/Eastern Iraq. Int J Res Med Sc. 2017; 5(10):4227–33. https://doi.org/10.18203/2320-6012.ijrms20174551.

Shahab F, Raziq F. Clinical presentations of acute leukemia. J Coll Physicians Surg Pak. 2014; 24(7):472–6.

Cvetković M, Mitrović M. Disseminated intravascular coagulopathy in non-promyelocytic acute myeloid leukemia: incidence, clinical and laboratory features and prognostic significance. Serbian Journal of the Medical Chamber. 2021; 2(2):99–109. http://dx.doi.org/10.5937/smclk2-32467.

Kim DY, Lee JH, Lee JH, Kim SD, Lim SN, Choi Y, et al. Significance of fibrinogen, D-dimer, and LDH levels in predicting the risk of bleeding in patients with acute promyelocytic leukemia. Leuk Res. 2011; 35(2):152–8. https://doi.org/10.1016/j.leukres.2010.05.022.

Chang H, Kuo MC, Shih LY, Dunn P, Wang PN, Wu JH, et al. Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia. Eur J Haematol. 2012; 88(4):321–8. https://doi.org/10.1111/j.1600-0609.2011.01747.x.

Libourel EJ, Klerk CPW, van Norden Y, de Maat MPM, Kruip MJ, Sonneveld P, et al. Disseminated intravascular coagulation at diagnosis is a strong predictor for thrombosis in acute myeloid leukemia. Blood. 2016; 128(14):1854–61. https://doi.org/10.1182/blood-2016-02-701094.