Related Experiment Videos
Sequential changes in platelet function and coagulation in leukemic children treated with L-asparaginase, prednisone,
Insights
This study shows that L-asparaginase therapy for acute lymphoblastic leukemia temporarily alters coagulation and platelet function in children. These changes may contribute to thrombosis risk during leukemia remission induction.
Area of Science:
- Pediatric Hematology
- Oncology
- Hemostasis and Thrombosis
Background:
- Acute lymphoblastic leukemia (ALL) treatment involves complex chemotherapy regimens.
- Induction therapy aims for remission but can cause hemostatic complications.
- Understanding coagulation and platelet changes is crucial for managing ALL patients.
Purpose of the Study:
- To investigate sequential changes in coagulation and platelet function during ALL induction therapy.
- To correlate these hemostatic alterations with potential thrombotic risks.
Main Methods:
- Sequential analysis of coagulation factors and platelet aggregation in 13 children with ALL.
- Therapy included L-asparaginase, prednisone, and vincristine.
- Measurements included plasma levels of plasminogen, antithrombin III, alpha 2-macroglobulin, fibrinogen, and platelet aggregation response to adenosine diphosphate.
Main Results:
- Early L-asparaginase therapy decreased levels of key coagulation factors (plasminogen, antithrombin III, alpha 2-macroglobulin, fibrinogen).
- Later in induction, clotting times shortened, factor V and VIII levels increased, and platelet counts recovered.
- Six patients showed increased platelet aggregation, correlating with shorter partial thromboplastin times.
Conclusions:
- Induction therapy for ALL induces dynamic hemostatic abnormalities.
- Concurrent coagulation and platelet dysfunction may explain thrombotic complications in some children.
- Monitoring hemostasis is vital during ALL remission induction.
Abstract:
Coagulation and platelet function in 13 children with acute lymphoblastic leukemia were studied sequentially during a remission induction with L-asparaginase, prednisone, and vincristine. In the first weeks of therapy, which included four doses of L-asparaginase coagulation was characterized by significant decreases in plasma concentrations of plasminogen, antithrombin III alpha 2-macroglobulin, and fibrinogen. All measures gradually returned to normal after complication of L-asparaginase therapy. In the latter part of induction treatment, clotting times, especially partial Thromboplastin time, decreased significantly, while levels of factors V and VIII increased with recovery of platelet counts. At this time, 6 patients had an increased in vitro platelet aggregation response to adenosine diphosphate, and their partial thromboplastin times were significantly shorter than those of patients without increased aggregation. Concurrent abnormalities in coagulation and platelet function may account for the thrombotic complications that develop in some children receiving induction therapy with these agents.