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Abstract：
BACKGROUND: While the presence of disseminated intravascular coagulation (DIC) has been implicated in worse clinical outcome in acute leukemia, the relationship between different subtypes of acute leukemia and the clinicopathologic features of DIC has not been systematically well studied.
METHODS: In this study, we retrospectively reviewed 149 cases of newly diagnosed acute leukemia and assessed the utility of evaluating red blood cell morphologic features, and coagulation parameters in determining the presence of DIC as well as differentiating subtypes of acute leukemia.
RESULTS: Review of our cohort demonstrates a novel finding, that elevated D-dimer concentrations ≥19 000 ng/mL fibrinogen equivalent units (FEU) are a sensitive diagnostic indicator of acute promyelocytic leukemia (APL) with moderate specificity, sensitivity 96%, specificity 92% in acute leukemia subtyping. Similar to other studies, APL showed an increased incidence of DIC (P < 0.01) compared to other subtypes of acute leukemia. Surprisingly, the presence of schistocytes on the peripheral blood smear was not a statistically significant indicator of DIC, sensitivity of 36% and specificity of 89%. Finally, the presence of DIC was not a significant indicator of poorer prognosis amongst all patients with AML.
CONCLUSIONS: Overall we identify elevated D-dimer concentrations ≥19 000 ng/mL FEU are a sensitive indicator of acute promyelocytic leukemia (APL), with a sensitivity of 96% and specificity of 92% in the subtyping of acute leukemias, and that the presence of schistocytes in peripheral blood smears is not a diagnostically sensitive screening test for DIC with a sensitivity of 36%.
METHODS: In this study, we retrospectively reviewed 149 cases of newly diagnosed acute leukemia and assessed the utility of evaluating red blood cell morphologic features, and coagulation parameters in determining the presence of DIC as well as differentiating subtypes of acute leukemia.
RESULTS: Review of our cohort demonstrates a novel finding, that elevated D-dimer concentrations ≥19 000 ng/mL fibrinogen equivalent units (FEU) are a sensitive diagnostic indicator of acute promyelocytic leukemia (APL) with moderate specificity, sensitivity 96%, specificity 92% in acute leukemia subtyping. Similar to other studies, APL showed an increased incidence of DIC (P < 0.01) compared to other subtypes of acute leukemia. Surprisingly, the presence of schistocytes on the peripheral blood smear was not a statistically significant indicator of DIC, sensitivity of 36% and specificity of 89%. Finally, the presence of DIC was not a significant indicator of poorer prognosis amongst all patients with AML.
CONCLUSIONS: Overall we identify elevated D-dimer concentrations ≥19 000 ng/mL FEU are a sensitive indicator of acute promyelocytic leukemia (APL), with a sensitivity of 96% and specificity of 92% in the subtyping of acute leukemias, and that the presence of schistocytes in peripheral blood smears is not a diagnostically sensitive screening test for DIC with a sensitivity of 36%.
摘要：
背景：虽然弥漫性血管内凝血（DIC）的存在与急性白血病的不良临床结局有关，急性白血病不同亚型与DIC临床病理特征之间的关系尚未得到系统的研究。
方法：在本研究中，我们回顾性回顾了149例新诊断的急性白血病，并评估了评估红细胞形态学特征的实用性，和凝血参数确定DIC的存在以及区分急性白血病的亚型。
结果：对我们队列的回顾表明了一个新的发现，D-二聚体浓度升高≥19000ng/mL纤维蛋白原当量单位（FEU）是急性早幼粒细胞白血病（APL）的敏感诊断指标，具有中等特异性，灵敏度96%,急性白血病亚型的特异性为92%。类似于其他研究，与其他亚型的急性白血病相比，APL的DIC发生率增加（P<0.01）。令人惊讶的是,外周血涂片上裂隙细胞的存在不是DIC的统计学显著指标，敏感性为36%，特异性为89%。最后,DIC的存在并不是所有AML患者预后较差的重要指标.
结论：总的来说，我们发现D-二聚体浓度升高≥19000ng/mLFEU是急性早幼粒细胞白血病（APL）的敏感指标，急性白血病亚型的敏感性为96%，特异性为92%，并且外周血涂片中分裂细胞的存在不是DIC的诊断敏感性筛查测试，敏感性为36％。
方法：在本研究中，我们回顾性回顾了149例新诊断的急性白血病，并评估了评估红细胞形态学特征的实用性，和凝血参数确定DIC的存在以及区分急性白血病的亚型。
结果：对我们队列的回顾表明了一个新的发现，D-二聚体浓度升高≥19000ng/mL纤维蛋白原当量单位（FEU）是急性早幼粒细胞白血病（APL）的敏感诊断指标，具有中等特异性，灵敏度96%,急性白血病亚型的特异性为92%。类似于其他研究，与其他亚型的急性白血病相比，APL的DIC发生率增加（P<0.01）。令人惊讶的是,外周血涂片上裂隙细胞的存在不是DIC的统计学显著指标，敏感性为36%，特异性为89%。最后,DIC的存在并不是所有AML患者预后较差的重要指标.
结论：总的来说，我们发现D-二聚体浓度升高≥19000ng/mLFEU是急性早幼粒细胞白血病（APL）的敏感指标，急性白血病亚型的敏感性为96%，特异性为92%，并且外周血涂片中分裂细胞的存在不是DIC的诊断敏感性筛查测试，敏感性为36％。
