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[Blood coagulation disorders in leukemia].

I Pabinger-Fasching1

  • 1Abteilung für Hämatologie und Blutgerinnung, I. Medizinischen Universitätsklinik Wien.

Wiener Medizinische Wochenschrift (1946)
|January 1, 1991
PubMed
Summary

Severe coagulation abnormalities affect over 50% of acute promyelocytic leukemia patients, increasing bleeding risks. Current treatments, including platelet replacement, have limited success in improving outcomes for acute myeloid leukemia patients with these conditions.

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Area of Science:

  • Hematology
  • Oncology
  • Coagulation Science

Context:

  • Bleeding and septicemia are leading causes of mortality in acute leukemia.
  • Severe coagulation abnormalities are observed in a significant portion of acute leukemia patients, particularly acute promyelocytic leukemia (APL).
  • Thrombocytopenia is a common finding, but severe coagulopathies present additional challenges.

Purpose:

  • To review the prevalence and potential etiologies of severe coagulation abnormalities in acute myeloid leukemia (AML) and APL.
  • To discuss the clinical implications, especially the risk of cerebral bleeding in APL.
  • To evaluate the efficacy of current therapeutic strategies.

Summary:

  • Severe coagulation abnormalities occur in ~12% of AML patients and >50% of APL patients.
  • Potential mechanisms include activation of coagulation, fibrinolysis, or leukocyte proteases, though the exact etiology remains unclear.
  • Cerebral bleeding is a significant risk in APL (10-15% of early deaths).
  • Intensified thrombocyte replacement is the primary therapeutic approach.
  • Additional treatments like heparin or antifibrinolytics have not improved prognosis.

Impact:

  • Highlights the high prevalence and unclear etiology of coagulopathies in APL, necessitating further research.
  • Underscores the limited success of current interventions, emphasizing the need for novel therapeutic strategies.
  • Informs clinical practice regarding the importance of aggressive platelet support and the limitations of other treatments.

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