Evidence of fibrinogen breakdown by leukocyte enzymes in a patient with acute promyelocytic leukemia.
On daunomycin treatment of a patient with promyelocytic leukemia, leukocyte elastase appeared in large amounts in the patient's blood. Also, the plasma fibrinogen was found to be partially degraded to early, X-like, fibrinogen degradation products. These early fibrinogen fragments were isolated and showed a low anticoagulant activity in a thrombin time test. Early fibrinogen degradation products, produced with leukocyte elastase in vitro, have a similar low anticoagulant activity. In contrast, plasmic degradation products inhibit clotting of fibrinogen to a large extent. Although alpha 2-antiplasmin and plasminogen levels were low, antithrombin III levels were not decreased. The low anticoagulant activity of the isolated fibrinogen fragments, the presence of elastase activity in the plasma--both immunological and amidolytic--and the normal levels of antithrombin III suggest that granulocytic enzymes, whose release was enhanced by the cytostatic treatment, were responsible for degradation of fibrinogen in this patient.
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000990:Antithrombin III / Q000032:analysis; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000209:etiology; D003630:Daunorubicin / Q000009:adverse effects* / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000378:metabolism*; D006098:Granulocytes / Q000187:drug effects* / Q000201:enzymology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000097:blood*; D013918:Thrombin Time
D000970:Antineoplastic Agents; D005338:Fibrin Fibrinogen Degradation Products; D000990:Antithrombin III; D005340:Fibrinogen; D010196:Pancreatic Elastase; D003630:Daunorubicin