Disseminated intravascular coagulation in acute leukemia: clinical and laboratory features at presentation

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Abstract
Background: Although there are two major scoring systems for the clinical diagnosis of disseminated intravascular coagulation (DIC), the validity of these systems for leukemia‐associated DIC remains to be confirmed. Methods: By analyzing 125 newly diagnosed acute leukemia patients, we investigated clinical and laboratory features of leukemia‐associated DIC, and determined the validity of the two established criteria. Results: A total of 36 patients (29%) were diagnosed with DIC according to expert opinion, a method regarded as the de facto gold standard. Leukemia‐associated DIC is characterized by rare manifestation of organ failure because of thrombosis and no relevance of the platelet count for the diagnosis. The results of receiver operating characteristics analysis favored fibrin degradation product (FDP) rather than D‐dimer as the fibrin‐related marker test. Although prothrombin time, plasma fibrinogen, and serum FDP levels were significantly different for patients with and without DIC, multivariate analysis identified FDP levels to be the only factor associated with DIC diagnosis. The cut‐off level of 15 μg/mL for FDP was found to be the most effective to differentiate DIC from non‐DIC, resulting in diagnostic sensitivity and specificity of 92% and 96%, respectively. The diagnostic results for our patients produced with this FDP‐based system were at least comparable with or superior to those obtained with the two currently available scoring systems. Conclusions: Our findings suggest that an FDP‐based criterion may be applicable for the diagnosis of leukemia‐associated DIC. Although it appears to be simple and practicable enough for clinical use, prospective validation of this criterion is needed.

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