Analysis Of Coagulation Abnormality And Related Risk Factors In Acute Myeloid Leukemia

Background and purposeAcute myelogenous leukemia(AML)is a malignant clonal disease of bone marrow hematopoietic stem cells.It is characterized by dysdifferentiation of hematopoietic stem cells,which leads to abnormal proliferation of immature tumor cells and inhibits normal hematopoiesis.Abnormal coagulation is a common manifestation of AML.Among them,patients with Acute promyelocytic leukemia(APL)are prone to abnormal coagulation,and fatal bleeding is the main reason for treatment failure.Currently,there are few reports about Non-APL AML coagulation.This topic retrospectively analysis the basic clinical characteristics,coagulation parameters and biochemical indicators of newly diagnosed AML patients in our hospital,and analyzes bleeding risks and risk factors,and compares Non-APL AML with AML patients,with a view to formulating different bleeding risk differences.The clinical treatment plan corresponding to the risk is of great significance for reducing the adverse events of bleeding in AML patients.MethodsThe clinical data of 96 cases of newly diagnosed AML who were continuously treated in our hospital from December 2014 to March 2019 were retrospectively collected.Among them,14 cases were excluded due to incomplete data,and 82patients who met the conditions of this study were included.The selected patients were divided into bleeding group and non-bleeding group according to whether bleeding occurred during the reception.All cases met the WHO diagnostic criteria.Patients’basic clinical information and bleeding situation,coagulation parameters and biochemical indicators were collected to analyze patients’basic clinical characteristics and bleeding situation,and to conduct bleeding-related risk factors research.Results1.This study included 82 newly diagnosed AML patients,including 47(57%)males and 35(43%)females,with a median age of 49.5 years(21-82 years).There were 22 cases diagnosed with APL and 60 cases patients with non-APL AML,and there were 73 cases(89%)with thrombocytopenia,and 41 cases(50%)with white blood cell increase,of which 6 cases had significantly increased white blood cells(>100×10~9/L).There were 43%(35 cases)of patients with bleeding symptoms,and no thromboembolism-related clinical manifestations were observed in all patients.Among them,the bleeding rate was 41%(7/17)in normal leucocyte patients,42%(10/24)in leucopenia patients,44%(18/41)in white blood cell increased patients,and50%(3/6)had a white blood cell count>100×10~9/L combined with bleeding symptoms.The bleeding rate of patients with platelet count≤20×10~9/L was 76%(22/29).Bleeding was not correlated with age,sex or normal karyotype(p>0.05),but with disease subtypes and the occurrence of DIC(p<0.05).2.Among the 82 patients,35(43%)had bleeding manifestations of varying degrees,and the incidence of APL bleeding was 68%(15/22),and that of non-APL AML bleeding was 33%(20/60).Non-APL AML bleeding is most common with skin and mucosal bleeding,and the common bleeding sites included petechiae,ecchymosis,bleeding gums,oral bleeding,etc.Only 2 cases had severe bleeding(1 case had hemoptysis and 1 case had gastrointestinal bleeding).In addition to skin and mucosal hemorrhage,about 1/3(5/15)of APL patients were associated with severe hemorrhage,including 1 case with cerebral hemorrhage,2 cases with urinary tract hemorrhage,and 2 cases with pulmonary hemorrhage.5 cases of hemorrhage in two or more parts,both are APL.3.Uniariate analysis results showed that PT,PLT count,FIB,ALT and total bilirubin were correlated with bleeding in the AML group compared with the non-bleeding group(p<0.05).In the bleeding group,ALT and total bilirubin were relatively increased,PT was relatively prolonged,and PLT count and FIB were relatively reduced.Compared with the Non-APL AML bleeding group,PLT count,total bilirubin and serum potassium were correlated with non-APL AML bleeding(p<0.05),in which PLT count and serum potassium were relatively reduced and total bilirubin was relatively increased.PLT count,WBC count,PT,FIB,ALT,AST and GGT were associated with APL bleeding in the bleeding group compared with the non-bleeding group(p<0.05).Results of multivariate logistic regression model analysis of the prediction of bleeding in different groups of patients:the predictive factors of early bleeding in AML group included PT,FIB,PLT count and LDH.In the Non-APL AML group,early bleeding predictors included WBC count,PLT count,and serum potassium value.Conclusions1.Bleeding is a common clinical manifestation in AML patients.Skin and mucosa bleeding is the most common.Compared with APL patients,Non-APL patients have less clinical bleeding,and bleeding in importantorgans can also be seen,which should not be ignored.2.Although there are many factors related to AML bleeding,high leukocyte count,thrombocytopenia,fibrinogen reduction,low serum potassium and high LDH are closely related to the risk of early bleeding in AML patients.It is of great significance to identify the risk factors of bleeding in AML patients and formulate the clinical treatment plan corresponding to the risk.