COAGULATION PATTERNS OF DISSEMINATED INTRAVASCULAR COAGULATION IN ACUTE PROMYELOCYTIC LEUKEMIA

Coagulation patterns of 19 newly-diagnosed acute promyelocytic leukemi a (APL) patients with disseminated intravascular coagulation (DIC) at presentation were studied. Seventeen patients had hemorrhagic complica tions, of which four were fatal. Fatal hemorrhages were related with l ower fibrinogen level and lower platelet count. DIC of the APL patient s without infection was characterized by low fibrinogen and normal ant ithrombin III (ATIII) level. Thrombin-ATIII complex level was elevated in all patients examined. Patients with infection had higher fibrinog en levels than those without infection and some patients had reduced A TIII level. Ten remission inductions were tried with multidrug chemoth erapy and seven with all-trans retinoic acid (ATRA). Complete remissio n was achieved in seven of ten inductions with chemotherapy and in all seven inductions with ATRA. Two patients treated with chemotherapy ha d fatal hemorrhage after starting therapy but none treated with ATRA. (C) 1997 John Wiley & Sons, Ltd.