급성전골수성백혈병과 다른 아형의 급성골수성백혈병에서의 혈관내 응고증 발생의 비교

Abstract

Background: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid luekemia characterized by a distinct morphology, clinical and molecular presentation. Up to 90% of APL patients present with hemorrhagic complications, secondary to disseminated intravascular coagulation (DIC). Hemorrhage in APL patient is one of the most serious problems which often lead to early death. It is recommanded that patients with presumptive diagnosis of APL and DIC should start ATRA without waiting for molecular confirmation. We report the result of comparison of DIC pattern between APL and other subtype of acute myeloid leukemia (AML).

Method: 9 patients diagnosed APL and 12 patients diagnosed other subtype of AML with presumed DIC between January 2005 and March 2011 were retrospectively reviewed

Result: INR (1.46 vs. 1.26, p=0.048) and FDP (82.86??g/mL vs. 17.12??g/mL, p=0.033) was more elevated and fibrinogen ( 138.94mg/dL vs. 358.83mg/dL ,p<0.001) was lower in the APL group compared to other subtype AML group. In addition, the APL group was higher neutrophil fraction (62.21% vs. 25.95%, p<0.001) than other subtype AML group.

Conclusion: There is marked difference between APL and other subtype of AML in INR, FDP, fibrinogen and neutrophil fraction. The diagnostic sensitivity of APL with ??3 laboratory criteria (neutrophil fraction ??40%, INR??1.4, FDP??25??g/mL Fibrinogen??250mg/dL) is 88.9% and specificity is 100%. They are helpful marker to early diagnosis of APL.