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Thrombin generation in acute promyelocytic leukemia
KA Bauer and RD Rosenberg
Six patients with disseminated intravascular coagulation (DIC) in
association with acute promyelocytic leukemia (APL) were studied with
sensitive radioimmunoassays that are able to quantitate the extent of
thrombin generation within the human circulation. The levels of prothrombin
activation fragment, F1 + 2, and thrombin-antithrombin complex (TAT) were
obtained at clinical presentation and were then followed serially in
several patients during induction chemotherapy. The antileukemic therapy
often resulted in a rise in the plasma levels of these molecular species.
Simultaneous measurements of fibrinopeptide A (FPA) were also obtained, and
the concentrations of this polypeptide were correlated with the levels of
F1 + 2 and TAT in patients who were not receiving heparin. Nine individuals
with other morphological subtypes of acute nonlymphocytic leukemia (ANLL)
were investigated and were usually found to have increased levels of F1 +
2, TAT, and FPA at clinical presentation. However, the magnitude of the
elevations was considerably greater and the correlation between TAT and FPA
levels was stronger in APL than in ANLL. These studies provide direct
evidence that patients with APL, as well as ANLL, generate excessive
amounts of thrombin within their vascular system. Furthermore, the data
suggest that the concentrations of F1 + 2, compared with the levels of FPA,
may be a more sensitive indicator of hemostatic system hyperactivity in
individuals with DIC.
Volume 64,
Issue 4,
pp. 791-796,
10/01/1984
Copyright © 1984 by The American Society of Hematology
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