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Disseminated Intravascular Coagulation in Leukemia and Lymphomas
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| Author:
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RASHMI GUDUR, ANAND GUDUR, RAVINDRA M.JOSHI
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| Abstract:
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Background: Disseminated intravascular coagulation (DIC) has been reported in majority of cases of hematolymphoid malignancies, but they often remain subclinical. Early detection of this complication probably may reduce morbidity and mortality associated with these malignancies.
Aim: To assessDIC and related abnormalities in leukemia and lymphomas and their clinical correlation.
Methods: In this prospective study, a total of 48 patients of either gender with confirmed diagnosis of either leukemia or lymphomas were included. At the time of presentation, the patient’s venous blood was collected for evaluatingthe complete blood count (CBC) and global coagulation parameters such as prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen and D-dimer levels. Statistical analysis was performed using software R version 3.6.0.
Results: Out of 48 patients, 52% had lymphoma and 48% had leukemia; majority had acute leukemia (65.2%) compared to chronic leukemia (34.8%).Nine (18.75%) patients had overt DIC.Sixteen (33.3%) and 17 (35.4%) patients had hepatomegaly and splenomegaly, respectively. Among 10 patients with active bleeding, 50% had overt DIC, 20% had thrombocytopenia (PC <20x109/L), 20% had tumor bleeding, and 20% had bleeding that was not clinicallyevident. The mean D-dimer levels were found to be high in acute leukemia (ALL: 3.79 ± 3.3 and AML: 6.4 ± 3) patients compared to chronic leukemia (CLL: 1.19±0.4 and CML: 3.09±2.7). Patients with leukemia were 6 (OR: 6.11, CI: 5-61.1) and 13 (OR: 12.8, CI: 0.3-65.7) times more likely to have bleeding and DIC, respectively, compared to lymphoma. A significant difference (P=0.001) was found only in the D-dimer levels in acute leukemia patients with respect to the presence and absence of DIC. Sensitivity and specificity D-dimer for predicting DIC in acute leukemia were found to be 87.5% and 85.7%, respectively.
Conclusion: Coagulation abnormalities are more often noted in leukemia compared to lymphoma and D-dimer assay can predict DIC in acute leukemia. Most of the times, DIC may remain sub clinical and is associated with bleeding more often in AML.
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| Keyword:
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Acute leukemia, bleeding, coagulopathy, acute myelogenous leukemia, ISTH criteria.
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| EOI:
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| DOI:
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https://doi.org/10.31838/ijpr/2020.12.03.399
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| Download:
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