Activation of coagulation system and d-dimer levels in children with acute leukemia

Background D-dimer is a molecule as result of breaking down
of excessive fibrin formation from the activation of coagulation
system. There is evidence of increased activation of coagulation in
patients with acute leukemia which was showed by the increment
of d-dimer levels.
Objective To evaluate the incidence of activation of coagulation
sys tem in children with acute leukemia before receiving
chemotherapy.
Method This cross-sectional study was performed at Dr. Cipto
Mangunkusumo Hospital. All newly-diagnosed children with acute
leukemia were included in this study, prior to their receiving any
chemotherapy treatment. Blast count, prothrombin time (PTI),
activated partial thromboplastin time (APTf), and D-dimer levels
were examined after the diagnosis was confirmed by morphology and
immunophenotyping studies on bone marrow specimens.
Results Out of 22 subjects, 13 subjects had increased D-dimer
values. The median D-dimer level of this elevated group was 1,000
(range 500-14, 700) n gfmL. In the acute myeloblastic leukemia
(AML) patients, activation of coagulation was found in 7 out of 8
subjects. The median D-dimer levels was 950 (range 100-14, 700)
ng/mL. In the acute lymphocytic leukemia (ALL) patients, 6 out
of 14 subjects had increased activation of coagulation with median
D-dimer level of 300 (range 100-3,800) ngfmL. Nine out of 10
subjects with blast cells on peripheral blood smear had a median
D-dimer level of 1,000 (range 500-3,800) ng/mL. Both PT and
APTT were found normal in all subjects.
Conclusion Activation of coagulation sys tem occurs at the
time of diagnosis as shown by increased D-dimer levels. The
characteristics of activation of coagulation system are different
between ALL and AML subjects, as well as between subj ects with
positive and negative blast counts on peripheral blood smears.
Despite the increased activation of coagulation, PT and APTf
remain normal.