Disseminated intravascular coagulation in acute promyelocytic leukaemia and its impact on the induction failure: a single centre study.

A Aziz,Abm Yunus,Al Kabir,F Rahman,Mn Baqui,Mr Khan,Tf Dipta

doi:10.3329/bmrcb.v39i2.19642

Abstract

Life-threatening coagulopathy associated with acute promyelocytic leukemia (APL) has been the defining clinical characteristic and is an important risk factor for fatal haemorrhage and early death. Pathogenesis of coagulopathy in APL is complex and mainly includes disseminated intravascular coagulation (DIC). The study was done to see the status of DIC and its impact on the outcome of APL in our setting. Among the total 60 patients, induction mortality rate was 30% and remission rate was 70%. The main cause of induction mortality was bleeding that accounts for 66.7% of mortality. DIC was present among 32 out of 60 patients (53.33%). Induction mortality has significant relationship to DIC as the induction mortality rate is 47% in patients with DIC and 11% in patient without DIC (P value 0.0009). Induction motality rate in low, intermediate and high risk group is 6.70%, 24% and 58% respectively (p value < 0.0001). Finally, risk group subclassification revealed presence of DIC in high risk group has the highest early mortality rate.

Highlights

Induction mortality remains a major problem and is an important cause of treatment failure in management of acute promyelocytic leukemia (APL) and haemorrhage still accounts for the majority of such early deaths[1]
The coagulopathy of APL has been characterized as a form of disseminated intravascular coagulation (DIC) 5
No such studies have been done in our country so the Knowledge about the status of DIC management in patients of APL and its impact on the outcome in our setting may be helpful for further evaluation and treatment of the patients

Summary

Introduction

Induction mortality remains a major problem and is an important cause of treatment failure in management of acute promyelocytic leukemia (APL) and haemorrhage still accounts for the majority of such early deaths[1]. Supportive cares and other minor diagnostic and therapeutic aspects may have a crucial importance in patient outcome especially in the contest of low socioeconomic status where early mortality is high and overall survival is poor due to lack of proper facilities, adequate awareness and multidisciplinary approach regarding the management[10,11,12]. No such studies have been done in our country so the Knowledge about the status of DIC management in patients of APL and its impact on the outcome in our setting may be helpful for further evaluation and treatment of the patients

Materials and Methods

Results

Conclusion