Assessment of coagulation disorders in patients with acute leukemia beforeand after cytostatic treatment

Coagulation disorders are often the reason for fatal bleeding in acute prom yelocytic leukemia. Their occurrence as well as pathogenesis and prognostic significance in other subtypes of acute myelogenous leukemia and acute lym phoblastic leukemia is less known. Tests were carried out in 70 patients in cluding 49 with AML and 21 with ALL. In all patients thrombin-antithrombin complexes (TAT), D-dimer (DD) and plasmin-antiplasmin complexes (PAP), anti thrombin III activity, fibrinogen/fibrin degradation products, APTT and PT were determined. The tests were performed on diagnosis and after cytostatic treatment. The level of TAT, DD and PAP was elevated in 83% of the patients on diagnos is and in 90% after treatment. The highest values were observed in AML M3 p atients. Among leukemic patients with normal levels of TAT, DD and PAP at d iagnosis, cytostatic treatment had a negligible effect on the level of thes e markers. During remission the levels of these markers returned to the nor mal values while in patients without remission they were either elevated or returned to normal values. No correlation between the levels of activation markers and remission rate was reported. DIC was diagnosed in 13 patients including three after chemotherapy. The DIC was acute or subacute in AML an d chronic in ALL patients. In the majority of acute leukemia patients there were already changes on di agnosis indicating coagulation activation. Except for AML M3, these usually had a subclinical course. The TAT, DD and PAP tests are not reliable marke rs of remission in acute leukemias.