Comparison of laboratory characteristics between acute promyelocytic leukemia and other subtypes of acute myeloid leukemia with disseminated intravascular coagulation.
BACKGROUND
Acute promyelocytic leukemia (APL) is an acute myeloid leukemia (AML) subtype with distinctive cell morphology, molecular presentation, clinical course, and treatment. About 90% of APL patients present with hemorrhagic complications due to disseminated intravascular coagulation (DIC). When APL is suspected, all-trans retinoic acid (ATRA) treatment is recommended even before confirmation by molecular tests. Specific criteria for differentiating unconfirmed APL from other AML subtypes with DIC are currently lacking. We aimed to achieve the early diagnosis of APL from other AML types with DIC by restricting the DIC criteria.


METHODS
We retrospectively analyzed 29 patients newly diagnosed with AML accompanied by DIC from January 2005 to January 2013.


RESULTS
Fibrin degradation products (FDP) (77.7 µg/mL vs. 23.7 µg/mL, p=0.026), D-dimer (7,376.2 ng/mL vs. 1,315.2 ng/mL, p=0.018), and TIBC (264.4 µg/dL vs. 206.8 µg/dL, P=0.046) were higher, while fibrinogen (133.8 mg/dL vs. 373.2 mg/dL, p<0.001), WBC (14.988×10(9)/L vs. 70.755×10(9)/L, p=0.015), and ESR (7.1 mm/h vs. 50.0 mm/h, p <0.001) were lower in APL patients than in the patients with other AML subtypes. FDP ≥27 µg/mL, D-dimer ≥2,071 ng/mL, and fibrinogen ≤279 mg/dL were our threshold values. These markers may be characteristic to APL and helpful in presumptive diagnosis.


CONCLUSIONS
APL may be differentiated from other AML subtypes by core markers of DIC (FDP, D-dimer, and fibrinogen). We suggest that clinicians set new diagnostic thresholds by restricting the DIC criteria. These findings support the early initiation of ATRA, prior to confirmation by PML-RARA molecular testing.
Department of Internal Medicine, Hematology-Oncology, Chosun University Hospital, Gwangju, Korea.
Hee-Jeong
HJ
Lee
Department of Internal Medicine, Hematology-Oncology, Chosun University Hospital, Gwangju, Korea.
Hyung-Jin
HJ
Park
Department of Internal Medicine, Hematology-Oncology, Chosun University Hospital, Gwangju, Korea.
Hyun-Wook
HW
Kim
Department of Internal Medicine, Hematology-Oncology, Chosun University Hospital, Gwangju, Korea.
Sang-Gon
SG
Park
Acute myeloid leukemia; Acute promyelocytic leukemia; Disseminated intravascular coagulation