Clinical Analysis Of 34 Cases Of Acute Promyelocytic Leukemia Patients With Disseminated Intravascular Coagulation

Acute promyelocytic leukemia (APL) is a distinct subtype of acute myelogenous leukemia (AML) which accounts for 10~15% of adult AML. There is a great amount of azurophil granule which contains affluent agglutinants and activators of plasminogen in leukemic cell. As leukemic cells proliferate or chemotherapy is administered, great deals of leukemic cells are demolished and then the agglutinants and activators of plasminogen are released to the peripheral blood. These substances activate coagulation system, which induces the formation microthromb in the recirculating system and the excessive consumption of the blood coagulation factor. As the result, fibrinolysis is stimulated. Hemorrhage becomes obvious and at last disseminated intravascular coagulation (DIC) develops. Before the mid-80s of last century, early mortality rate of APL reaches as high as above 30-40% because of the complications of hemorrhage and DIC. Since all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) are used for the treatment of APL differentiation, the remission rate greatly improved and early mortality has been greatly decreased. But the majority of APL patients combine with the complication of DIC, and there are still a small number of patients die in the early stage because of DIC. It is of great significance to make early diagnosis and treatment of APL patients with DIC and promptly suspension of the development of DIC to improve survival, quality of life and reduce mortality. In our paper, we made a retrospective analysis of 34 cases of APL with DIC enrolled in our hospital from 1999 to 2007. We intended to study the features of the clinical and laboratory results and the characteristic treatment of these patients.Objective:We studied the features of the clinical and laboratory data and the treatment of APL patients with DIC, and analysed the correlation factors with morbidity and prognosis of DIC. Patients and Methods:Retrospective analysis was used in the study. Clinical data including general state, clinical symptom, laboratory examination, therapeutic measure and therapeutic effect were collected and analysed.Results:(1) There were 202 APL patients of whom 34 cases complicated DIC with inception rate of 16.8%. The inception rate of DIC in the initial treatment group was 19.9% which is higher than that of palindromia group (7.8%), and the sifference is significant (p<0.05). The count of WBC and hematogone of peripheral blood correlated with the occurrence while the value of OR were 4.24 and 3.56 respectively. (2) The total occurrence of hemorrhage was 97.1%, among which skin and mucosal bleeding were the most common. The occurrence of bleeding of more than three locations was 85.3% which is significantly higher than that of control Group (43.2%) (p<0.01). (3) 28 cases (82.4%) had hyperleukocytosis, of which 14 cases had a high level of leukocytes at admission and 14 cases developed hyperleukocytosis during the therapy of induction and differentiation. The accounts and dynamic change of platelet in 34 cases were consistent with the dignosis criteria of DIC. The positive rate of abnormality of PT, APTT, FIB and D-dimeride were respectively 79.4%, 38.2%, 85.3% and 92.3%. (4) Of all the APL patients with DIC, 32cases received therapy of induction while the remission rate was 56.3% and time for remission was 25~45d with an average time of 33.2d. Whereas the remission rate in control group was 79% and time for remission was 24~34d with an average time of 29.8d. There were significant differences between the two groups in remission rate and time for remission. (5) Of all the patients 32 cases received the therapy of heparin. Among these, 21 cases (65.6%) achieved a positive effect. The difference of effect between common heparin and low molecular heparin wasn't significant (p>0.05). 13 cases received the combining therapy of heparin and anti-fibrinolysis. And compared with patients with only heparin therapy, there was no significant difference in effect (p>0.05). (6) The regression analysis of correlation factor with prognosis showed that age, numbers of bleeding positions, the level of plasma LDH and the counts of peripheral blood leukocyte correlated with the progonosis of DIC.Conclusions1.The APL patients complicated with DIC is more in initial phase, and hyperleukocytosis is the high risk factor.So we should preclude DIC earlier.2. In our study the occurrence of hemorrhage in APL patients with DIC was 97.1%, and there was the bleeding of unrelated multi-position among which skin and mucosal bleeding were the most common. Intracranial hemorrhage is the main cause of death.3. The valuable index for monitoring DIC is D-dimeride for its high positive rate in APL complicated DIC.4. The APL patients complicated with DIC could result in a lower remission rate and longer time for remission.5. There wasn't obvious different effect between common heparin and low molecular heparin. Otherwise,side effects of low molecular heparin were less,and the medication was convenient,so low molecular heparin can substitute common heparin in clinic.6. Age, numbers of bleeding positions, level of plasma LDH and the counts of peripheral blood leukocyte correlated with the progonosis of DIC.