ISSN 2997-1036
International Journal of Hematology | Vol. 8, No. 12, December 2017 | pp. 89–96
DOI: 10.46882/2017/IJH/000096
Original Article
Title: Evaluation of baseline plasma antithrombin III activity as an independent predictor of induction mortality in acute promyelocytic leukemia
Names of Authors: E. F. Chinedu¹, G. H. Haruna², I. J. Balogun³
Authors’ Affiliations: ¹Department of Haematology, University of Nigeria Teaching Hospital, Enugu, Nigeria; ²Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria; ³Department of Chemical Pathology, University of Ilorin, Ilorin, Nigeria
Abstract: Acute promyelocytic leukemia drives a catastrophic consumptive coagulopathy resulting in severe intracranial hemorrhage during initial induction therapy. This prospective study evaluated baseline plasma antithrombin III activity levels in 32 adult patients with newly diagnosed acute promyelocytic leukemia harboring the t(15;17) PML-RARA translocation to assess its value for predicting early induction survival. Antithrombin III activity was quantified via chromogenic substrate assays prior to starting all-trans retinoic acid and arsenic trioxide induction. Severe antithrombin III depletion (< 60.0%) was identified in 28.1% (9 of 32) of the patients. Multivariable logistic regression revealed that baseline antithrombin III activity below 60.0% was an independent predictor of early fatal hemorrhagic complications within the first 14 days of therapy (odds ratio = 4.82, P < 0.01). Furthermore, depressed antithrombin III levels correlated strongly with high D-dimer values and low fibrinogen concentrations. Profiling baseline functional antithrombin III provides high clinical utility, helping identify promyelocytic leukemia patients requiring aggressive supportive fresh frozen plasma or antithrombin concentrate interventions.
Keywords: Acute promyelocytic leukemia, antithrombin III, consumptive coagulopathy, early mortality, prognosis
Manuscript Timeline: Received: September 05, 2017; Revised: October 14, 2017; Accepted: November 05, 2017; Published: December 14, 2017