Elsevier

Blood Reviews

Volume 4, Issue 4, December 1990, Pages 245-251
Blood Reviews

Haemostatic problems in acute leukaemia

https://doi.org/10.1016/0268-960X(90)90004-CGet rights and content

Abstract

Disseminated intravascular coagulation (DIC) is a frequent complication of acute leukaemia, in particular acute promyelocytic leukaemia. Although procoagulant substances released from leukaemic blast cells may induce DIC by activating conventional coagulation pathways, there is increasing evidence to suggest that direct activation of fibrinogen by proteases released from blast cells may be the predominant mechanism by which DIC is initiated. Primary fibrinolysis has also been proposed as the cause of the haemorrhagic diathesis in some cases of acute leukaemia. Although plasminogen activators have been demonstrated in leukaemic blast cells supporting this view, cases of primary fibrinolysis would appear to be rare. A bleeding tendency attributed to primary fibrinolysis may more often be the result of an exaggerated fibrinolytic response secondary to DIC. The main strategies of treatment for leukaemia associated DIC are rapid initiation of chemotherapy and vigorous blood product support until the DIC resolves once the blast cells have been eradicated. The role of heparin in the management of leukaemia associated DIC remains controversial. There is recent evidence to suggest that heparin therapy does reduce the incidence of haemorrhagic death although it has been recommended that relatively low intravenous doses should be administered initially to reduce the risk of heparin induced haemorrhage.

References (53)

  • MS Brower et al.

    Proteolytic cleavage and inactivation of alpha2-plasmin inhibitor and C1 inactivator by human polymorphonuclear leukocyte elastase

    Journal of Biological Chemistry

    (1982)
  • R Egbring et al.

    Demonstration of granulocyte proteases in plasma of patients with acute leukaemia and septicaemia with coagulation defects

    Blood

    (1977)
  • J Bernard et al.

    Acute promyelocytic leukaemia. Results of treatment with daunorubicin

    Blood

    (1973)
  • HM Kantarjian et al.

    Acute promyelocytic leukemia. The MD Anderson Hospital experience

    American Journal of Medicine

    (1986)
  • LK Hillestad

    Acute promyelocytic leukaemia

    Acta Medica Scandinavia

    (1957)
  • JJ Rand et al.

    Coagulation defects in acute promyelocytic leukaemia

    Archives of Internal Medicine

    (1969)
  • SH Goodnight

    Bleeding and intravscular clotting in malignancy: A review

    Annals of the New York Academy of Science

    (1974)
  • HR Gralnick et al.

    Annotation—Acute promyelocytic leukaemia: haemorrhagic manifestation and morphologic criteria

    British Journal of Haematology

    (1975)
  • J Lisiewicz

    Disseminated intravascular coagulation in acute leukaemia

  • E Gluckman et al.

    Combination chemotherapy with cytosine arabinoside and rubidomycin in 30 cases of acute granulocytic leukaemia

    Cancer

    (1973)
  • AJ Collins et al.

    Acute promyelocytic leukaemia—management of the coagulopathy during daunorubicin-prednisolone remission induction

    Archives of Internal Medicine

    (1978)
  • LAA Champion et al.

    Disseminated intravascular coagulation in childhood acute lymphoblastic leukaemia with poor prognostic features

    Cancer

    (1978)
  • M Bennett et al.

    Platelet and fibrinogen survival in acute promyelocytic leukaemia

    British Medical Journal

    (1976)
  • NA Booth et al.

    Plasmin-alpha2-antiplasmin complexes in bleeding disorders characterised by primary or secondary fibrinolysis

    British Journal of Haematology

    (1984)
  • B Bennett et al.

    Haemorrhage in acute promyelocytic leukaemia (APL); DIC or fibrinolysis

    British Journal of Haematology—Abstract supplement

    (1988)
  • A Polliack

    Acute promyelocytic leukaemia with disseminated intravascular coagulation

    American Journal of Clinical Pathology

    (1971)
  • Cited by (21)

    • High syndecan-1 levels in acute myeloid leukemia are associated with bleeding, thrombocytopathy, endothelial cell damage, and leukocytosis

      2013, Leukemia Research
      Citation Excerpt :

      There is a strong association between platelet count and the risk of hemorrhage in acute leukemia [7], although clinical bleeding can still be evident despite normal platelet counts. The bleeding tendency is influenced by a multitude of factors such as disseminated intravascular coagulation (DIC), hyperfibrinolysis [8], platelet function defects [9–11], fever, infection [3], the leukemia phenotype (APL), hyperleukocytosis [12] and administration of drugs that interfere with platelet function [13]. In general, dysfunction of the inner lining of the vessel wall, the endothelium, contributes significantly to capillary leakage and bleeding [14].

    • Bleeding problems in the cancer patient

      1992, Hematology/Oncology Clinics of North America
    View all citing articles on Scopus
    View full text