| Clinical bleeding events and laboratory coagulation profiles in acute promyelocytic leukemia. | |
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MedLine Citation:
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PMID: 22221178 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background: Bleeding is the leading cause of death for patients with acute promyelocytic leukemia (APL). Blood component transfusion to correct coagulopathy is the keystone in reducing bleeding. The benefit of fresh frozen plasma transfusion is unproven. Using laboratory profiles to predict bleeding is important guidance for determination of transfusion policies in treatment of APL. Design and Methods: For 116 patients of APL, bleeding events were collected and correlated with various hematologic and coagulation parameters, including leukemic cell percentages, white blood cell (WBC) and platelet counts, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen levels, and disseminated intravascular coagulation (DIC) scores. Results: Overt DIC occurred in 77.6% of patients. Severity of DIC was associated with bone marrow leukemic cell percentages but unrelated to bleeding. Patients with bleeding had significantly higher WBC counts (26.73±6.18 vs. 13.03±3.03 μL(-1) , p=0.026) and more prolonged PT (4.85±0.70 vs. 2.59±0.28 seconds, p=0.002) and APTT (3.98±1.68 vs. 0.96±0.93 seconds, p=0.017). Fibrinogen levels, platelet counts and leukemia cell percentage were not significantly different between bleeding and non-bleeding patients. PT is valuable in prediction of bleeding. Patients with PT≧5 seconds had a relative risk of 6.14 for bleeding. Seven patients had severe bleeding before initiation of all-trans retinoic acid (ATRA). Conclusions: Patients with APL are susceptible to DIC and subsequent bleeding events. Prompt ATRA administration is crucial in preventing hemorrhagic events. High WBC counts, prolonged PT and APTT are associated with clinical bleeding in our series. PT is the most accurate parameter in predicting bleeding. Based on these findings, supportive care should be directed towards correction of coagulopathy to prevent bleeding complications and fresh frozen plasma appears to be indicated for coagulopathy associated with APL. © 2011 John Wiley & Sons A/S. |
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Authors:
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Hung Chang; Ming-Chung Kuo; Lee-Yung Shih; Po Dunn; Po-Nan Wang; Jin-Hou Wu; Tung-Liang Lin; Yu-Shin Hung; Tzung-Chih Tang |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-30 |
Journal Detail:
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Title: European journal of haematology Volume: - ISSN: 1600-0609 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2012-1-6 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8703985 Medline TA: Eur J Haematol Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 John Wiley & Sons A/S. |
Affiliation:
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Division of Hematology-Oncology, Chang Gung Memorial Hospital, and School of Medicine, Chang Gung University, Taipei, Taiwan. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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