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[Acquired deficiencies in antithrombin III and C protein during treatment with L-asparaginase]
Insights
L-Asparaginase therapy for leukemia caused severe deficiencies in antithrombin III and protein C in children. This hypocoagulability may explain the absence of blood clots despite risk factors.
Area of Science:
- Hematology
- Pediatric Oncology
- Pharmacology
Context:
- Acute lymphoblastic leukemia (ALL) treatment often involves L-Asparaginase.
- Children undergoing ALL therapy face potential thrombo-embolic risks.
- Coagulation profiles require monitoring during L-Asparaginase treatment.
Purpose:
- To investigate the impact of L-Asparaginase on coagulation parameters in pediatric ALL patients.
- To assess levels of major coagulation inhibitors, antithrombin III and protein C.
- To correlate observed coagulation changes with thrombo-embolic event occurrence.
Summary:
- Sequential coagulation studies were performed on 14 children with ALL treated with L-Asparaginase.
- Severe deficiencies in antithrombin III and protein C were observed during therapy.
- A state of hypocoagulability was noted, potentially mitigating thrombo-embolic risks.
Impact:
- Findings suggest L-Asparaginase significantly affects coagulation pathways.
- The observed hypocoagulability may offer a protective effect against thrombosis in certain pediatric ALL cases.
- Highlights the need for careful risk-benefit assessment and potential prophylactic strategies in high-risk patients.
Abstract:
Fourteen children treated by L-Asparaginase for acute lymphoblastic leukemia had sequential coagulation studies performed including cephalin-kaolin time, Quick time, fibrinogen, factors II, VII + X and V, as well as antithrombin III and protein C, the major coagulation inhibitors. A severe antithrombin III and protein C deficiency was observed during therapy, with a coexisting hypocoagulability. This equilibrium partially explains the lack of thrombo-embolic phenomena in these children, despite the risk factors present. Although no substitutive therapy was instituted in these cases, their use in high-risk cases is discussed.