Original article

Vol. 22 No. 1 (2024): Blood Transfusion 1-2024 (January-February)

Global hemostasis assays in acute myeloid leukemia: results of an observational prospective study

Authors

Key words: thromboelastography, acute myeloid leukemia, thrombosis, hemorrhage
Publication Date: 2023-06-12

Abstract

Background - Acute myeloid leukemia (AML) is characterized by a complex spectrum of coagulopathy ranging from hemorrhagic to thrombotic symptoms. To date, platelet count (PLT) and conventional coagulation tests (CCTs) cannot predict hemorrhagic events and thrombotic risk. Thromboelastography (TEG) measures the viscoelastic properties of the clot, thus providing information on the entire process of blood coagulation. The primary aim of the study was to assess the hemostatic balance from AML diagnosis to the end of chemotherapy (CHT) by TEG.
Material and methods - Here we present the results of a prospective study enrolling newly diagnosed AML patients treated with chemotherapy. Patients had complete blood counts (CBCs), TEG and CCTs performed at three time points: 1) diagnosis (T0); 2) during the first cycle of CHT (T1); and 3) at the end of CHT (T2). An algorithm of TEG indirectly calculated thrombin generation (TG). Patients underwent daily follow-up for bleeding and thrombotic episodes up to the time of hospital discharge or death.
Results - Eighty consecutive patients were evaluated; forty were eligible for the study, and 21 completed the entire study. At T1, maximum amplitude (MA), TG and K-time were significantly shifted toward a hypocoagulability state compared to T0 (p<0.05), while a hypercoagulable state at T2 was shown by changes in α-angle, MA and TG values. Otherwise, there were no statistically significant differences in CCTs between the evaluated time points.
Discussion - Overall, TEG revealed complex and dynamic coagulation abnormalities in patients with AML according to both the course of disease and therapy. Further studies are needed to investigate more fully the role of TEG in defining the hemostatic profile in patients with AML.

Additional Files

Authors

Simona Raso - University of Palermo, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), Palermo, Italy; Department of Hematology and Rare Diseases, V Cervello Hospital, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy https://orcid.org/0000-0002-0967-2191

Alessandro Lucchesi - Hematology Unit, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) “Dino Amadori”, Meldola, Italy https://orcid.org/0000-0002-0624-5311

Mariano Sardo - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo and Policlinico Paolo Giaccone, Unit of Haematology, Palermo, Italy

Ombretta Annibali - Hematology Unit, Campus Bio-medico, University of Rome, Rome, Italy https://orcid.org/0000-0002-3095-5313

Vincenzo Sucato - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo and Policlinico Cardiology Unit, Paolo Giaccone, Palermo, Italy https://orcid.org/0000-0001-9514-1575

Marcello Ciaccio - Department and U.O.C. Laboratory Medicine, "Paolo Giaccone” University Hospital, Palermo, Italy; 8Istituto di Statistica, ISTAT, Palermo, Italy https://orcid.org/0000-0001-6120-9041

Silvana Vitale - Department and U.O.C. Laboratory Medicine, "Paolo Giaccone” University Hospital, Palermo, Italy; 8Istituto di Statistica, ISTAT, Palermo, Italy

Alberto Dolce - Istituto di Statistica, ISTAT, Palermo, Italy https://orcid.org/0000-0002-7996-8369

Giulio Giordano - Division of Internal Medicine, Hematology Service, Regional Hospital "A. Cardarelli", Campobasso, Italy https://orcid.org/0000-0002-6932-5028

Sergio Siragusa - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo and Policlinico Paolo Giaccone, Unit of Haematology, Palermo, Italy https://orcid.org/0000-0002-1641-6508

Mariasanta Napolitano - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University of Palermo and Policlinico Paolo Giaccone, Unit of Haematology, Palermo, Italy https://orcid.org/0000-0001-8934-2936

  • Abstract viewed - 573 times