الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Coagulopathies due to activation of coagulation factors or fibrinolysis arise in a significant proportion of patients with acute leukemia (Raul et al., 1986). Coagulopathy was associated with a poor treatment outcome in patients with either ALL or AML, although intensive chemotherapy has improved the survival rates
of patients with leukemia (Gale, 1984).
Leukemic cells contain procogulant activity (Galnick, 1981), fibrinolytic activity (Sakawagawa, 1976), X activator activity, elastase like activity and chemotrypsin like activity
(Varadi, 1980).
In this study, Hb level, WBCs count, B.M. blasts % and coagulation screening tests were assayed in 45 patients (16 ALL, 12 AML, and 17 relapsing acute leukemia, to evaluate the effect of disease and chemotherapy as a cause of coagulopathy.
Group I ALL patients showed low pretreatment values of Hb level and platelet count which were significantly increased to approach normal values post-treatment. BM blasts % and WBC were high in all cases before treatment, yet all ALL patients went into complete remission post chemotherapy. It was noted that fibrinogen level was the only coagultion index which showed significant decrease statistically after chemotherapy. This was attributed to the fact that our cases were treated with L-asparaginase in addition to vincristine and prednisone, although none of them experienced serious hemorrhagic or thrombotic
complications. As regards, the comparative analysis between ALL FAB subtypes and hemostatic parameters before treatment, it was observed that PTC, PTT and fibrinogen appear better and close to normal in L I than L2 and L3 which may be related to the liver
synthesis of coagulation factors on which these parameters depend.
statistically
in HI) level, WBCs count and BM blasts % as in ALL cases where
Hb level and platelet count were low before treatment and
approached normal after treatment, while WBC count and B.M.
blast % were high before treatment and became within the normal range after treatment. As regards coagulation indices, PTT was the only index which prolonged somehow after treatment but remained within the normal range. This may be due to that AML cases have a more severe coagulopathy amplified during leukemic cell lysis (Raul et al., 1986). Correlation between FAB subtypes and hemostatic disturbances in AML statistical analysis could not be performed due to low number of cases in the subtypes, but we can postulate that MI showed mild decrease in PTC, MS showed a moderate decrease while M3 showed very low level, which could be due to high consumption coagulopathy. MI, M3, M5 showed the longest PIT (prolonged PTT) and decreased fibrinogen level before treatment. Regarding the relation between the FDP and AML, FDP was the subject of insult of the leukemic process. The literature is poor regarding the correlation between
leukemia subtypes and hemostasis.
Group II AML cases showed the same
results
Group III relapsed acute leukemia, WBC and BM blasts % were high before treatment and decreased significantly after treatment. As regards platelets count, it increased nearly to normal range after treatment while there is no significant change before and after treatment in the other studied coagulation
indices.
It was concluded that chemotherapy according to the new protocol of treatment was in general not detrimental to the coagulation process in treated cases, but rather generally had a beneficial effect.
1.The new protocol of chemotherapy for cases of acute leukemia was shown to be generally not detrimental to the
coagulation process in treated cases, rather it was shown to have
a beneficial effect in most cases.
2.Some coagulopathies were observed in individual studied cases either before treatment or after treatment. These coagulopathies were sometimes related to the original
condition of the patient or to chemotherapy particularly L-asparaginase.
3.In addition to CBC and bone marrow studies, which are the cornerstone of diagnosis and follow up of cases of acute leukemia. We suggest regular use of PTC, PTT, fibrinogen and FDPs to follow up the possibility of coagulopathies which
may lead to serious complications during the course of management of some cases.
4.In general more hemostatic alterations were noticed in AML as compared to ALL. Therefore it is recommended that cases of AML should be closely monitored for the possibility of
developing a coagulopathy throughout the course of their management.
5.No significant correlation was observed between hemostatic alterations and immunophenotyping, but it is recommended to
pursue a study on a larger number of cases for appropriate statistical evaluation.
6.There seems to be a prominent association between hemostatic disturbances and some FAB subtypes of ALL and AML. This alteration was more apparent in L2 and L3 than in LI, and more in MS and M3 than MI and M2. Further evaluation of this association is recommended in larger
studies in the future.
7.Extension of the correlation between hemostatic alteration in AL and immunophenotype and FAB, more larger number of
cases is recommended.