Haemostatic parameters in acute promyelocytic leukemia patients treated with All Trans-Retinoic Acid (ATRA).


Background: Acute Pormyelocytic Leukemia (APL) is commonly associated withDisseminated Intravascular Coagulation (DIC)1,2.Objective: The work was conducted to identify patients with APL who showlaboratory evidence of DIC (clinical or subclinical) with serial laboratory follow up.Subjects and Methods: In this study 44 newly diagnosed APL patients were included. Foreach patient, full hemostatic investigations were done at time of diagnosis and repeated onday 3 and day 7 of therapy.Results: Before starting therapy, all patients had elevated levels of D-dimer, indicating thepresence of DIC. On day 7 of treatment, plasma D-dimer levels were normal in ATRA-treated group, but were high in the chemotherapy treated group, indicating that DIC wasessentially resolved in ATRA treated patients.Conclusion: DIC is commonly encountered at presentation in patients with APL,necessitating a rapid and full coagulation study in all patients. ATRA therapy in APLpatients is associated with rapid improvement of coagulopathy, hence it will aid thosepatients to pass quickly the critical period of DIC. Therefore, ATRA therapy is justified tobe used from day one of treatment in APL patients.