Disseminated Intravascular Coagulopathy; a Condition to Monitor in the Management of Leukaemia Patients

Background: Disseminated intravascular coagulopathy is a consumption coagulopathy which mostly results from an underlying disease. It occurs as a result of the activation of the coagulation cascade leading to the formation of thrombi which results in haemorrhage due to the excessive consumption of platelet and coagulation factors. Malignancy is associated with hypercoagulable state and increased risk for thrombohemorrhagic complications and leukaemia is no exception. Bleeding manifestations are common in acute leukemias, especially in acute myeloblastic leukemia, and are prominent features of an initial stage of the disease. This study assessed disseminated intravascular coagulopathy (DIC) in leukaemia patients in Nigeria.

Materials and Methods: One hundred and sixteen (116) subjects consisting of 58 leukaemic subjects (AML, CLL, and CML) and 58 age and sex-matched healthy control subjects were recruited into the study. The parameters estimated in this study were packed cell volume (PCV), platelet count, white blood cell count (WBC), prothrombin time (PT), the international normalised ratio (INR), activated partial thromboplastin time (aPTT) and D-dimer assay.

Results: The mean ± SD values of the parameters assessed in the leukaemia patients include 3.7±3.1 µg FEU/mL, 67.5±55.7 seconds, 1.8±0.1, 77.3±31.8 seconds, 194±103 cells/mm3, 74±124 cells/mm3, 30±5% for D-dimer, PT, INR, aPTT, platelets, WBC and PCV respectively. The results display a significant statistical difference between the leukaemic and the control subjects (p<0.05).

Conclusion: The abnormality of these haemostatic parameters occurring in the leukaemic subjects (AML, CLL, and CML) is highly indicative of the occurrence of disseminated intravascular coagulopathy in these patients. This study, therefore, shows that disseminated intravascular coagulopathy can occur as a complication of various types of leukaemia studied and this requires prompt and appropriate management.