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Volume 2
July 24-25, 2019 | Rome, Italy
World Hematology 2019 & Nursing Care 2019
July 24-25, 2019
Journal of Blood Disorders and Treatment
47
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WORLD CONGRESS ON NURSING CARE
11
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WORLD HEMATOLOGY AND ONCOLOGY CONGRESS
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Disseminated intravascular coagulation in acute promyelocytic leukemia: Pathogenesis,
clinic and treatment: Our experience
Xheni Ngjela, Polikron Pulluqi, Marsela Shani, Elsuarta Calliku
University Medical Center of Tirana "Mother Teresa", Albania
Background
: Disseminated intravascular coagulation is characterised by systemic activation of blood coagulation, which
results in generation and deposition of fibrine, leading to microvascular thrombi in various organs and contributing to multiple
organ dysfunction syndrome. Derangement of the fibrinolytic system in some cases may cause severe bleeding. In hematologic
malignancies DIC is often seen in acute promyelocytic leukemia. There are two main elements in the pathogenesis of DIC caused
by APL, hypercoagulability and hyperfibrinolysis. In hypercoagulation the main factors are elevation of TAT and fibrinopeptide
A levels. Leukemic cells produce different types of coagulation factors such as tissue factors (TF)CP and microparticles (MPs).
The coagulation cascade is activated by TF-factors VIII complex which activates factor X and leads to thrombi formation.
Hyperfibrinolysis in patients with APL is explained by hypofibrinogenemia, decreased levels of plasminogen, a2 antiplasmin
and plasminogen activator inhibitor 1(PAI 1) One of the most important factors responsible for exaggerated fibrinolysis in these
patients is the expression of ANEXIN II and TAFI by leukemic cells.
Study
: For this purpose, have been used data provided by the “Mother Teresa University Hospital” Statistical Service and data
collected from the register of malignant diseases for the period 2007-2017.
A total of 48 cases diagnosed with APL were treated by the hematology service for the years 2007-2017, out of which 22 women
(47%) and 26 males (53%). The average age of the affected was 45 years. Clinically they were presented with signs of DIC with
hemorrhagic phenomena (metroraghia, epistaxis, petechie, echimosis) and also an increased tendency for bleeding mainly at the
sites of manipulation.
Thrombocitopenia, low levels of fibrinogen and PT were the main laboratory findings.2/3 of all APL cases were pancytopenia
at the moment of diagnosis.
The treatment is based on immediate beginning of specific chemotherapy (3+7, ATRA) which reduces the leukemic mass leading
to DIC improvement. On the other hand, the supportive care was also important. We use fresh frozen plasma, platelets and red
blood cells transfusions in order to achive safe levels of fibrinogen (100mg/dl) and platelets (50.000/mm3)
Results
: Disseminated intravascular coagulation is characterised by systemic activation of blood coagulation, which results
in generation and deposition of fibrine, leading to microvascular thrombi in various organs and contributing to multiple organ
dysfunction syndrome. Derangement of the fibrinolytic system in some cases may cause severe bleeding. A total of 48 cases
diagnosed with APL were treated by the hematology service for the years 2007-2017, out of which 22 women (47%) and 26
males (53%). The average age of the affected was 45 years. 2/3 of all APL cases were pancytopenia at the moment of diagnosis.
The treatment is based on immediate beginning of specific chemotherapy (3+7, ATRA).
marselashani17@gmail.comJ Blood Disord Treat, Volume 2