Disseminated intravascular coagulation scoring in children with newly diagnosed acute leukemia

Abstract

Background Patients with acute leukemia (AL) commonly present with abnormalities in laboratory tests of blood coagulation. Coagulation abnormalities and disseminated intravascular coagulation (DIC) have been extensively studied in acute promyelocytic leukemia, but only a limited number of studies addressed this issue in children with other types of AL. Objective The aim of this study was to detect DIC by using the International Society of Thrombosis and Haemostasis scoring system, for both nonovert and overt DIC, among newly diagnosed children with AL. Participants and methods The study was a diagnostic test accuracy study including 25 children presenting with newly diagnosed AL (lymphoblastic and myeloid) and admitted to the Hematology–Oncology Unit at Alexandria University Children’s Hospital. They were consecutively recruited between October 2016 and March 2017. Coagulation studies including prothrombin time, D-dimer, fibrinogen, antithrombin III, and protein C levels were assessed, and the International Society of Thrombosis and Haemostasis scoring system was used for defining nonovert and overt DIC. Results The age of patients included in the present study ranged from 17 to 149 months, with a median of 48 months; males and females were almost equally represented. At baseline assessment, 10 (40%) of 25 patients had a positive overt DIC score and only seven (28%) of 25 had a positive nonovert DIC score. Bleeding manifestations were a common problem in the present study, as 16 (64%) patients presented with bleeding symptoms, being more frequently in patients with an overt DIC positive score (P=0.040). The median platelet count (P=0.023), D-dimer level (P=0.000), and fibrinogen level (P=0.010) showed a significant statistical difference between patients with either positive or negative overt DIC score, whereas neither white blood cells count, absolute blasts count, hemoglobin, prothrombin time, antithrombin III nor protein C levels did. Conclusion Our data confirm that children with AL have some hemostatic derangement at baseline. A positive overt or nonovert DIC score was not statistically related to a worse end of induction remission status or a significantly higher 28-day mortality rate. Larger multicenter studies are needed to determine the most clinically relevant hemostatic abnormalities and adapt more sensitive and specific scoring system for DIC in children with hematological malignancies.