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Semin Thromb Hemost 2010; 36(4): 388-403
DOI: 10.1055/s-0030-1254048
© Thieme Medical Publishers

Disseminated Intravascular Coagulation in Hematologic Malignancies

Massimo Franchini1 , Matteo Nicola Dario Di Minno2 , Antonio Coppola2
  • 1Department of Pathology and Laboratory Medicine, Immunohematology and Transfusion Center, University Hospital, Parma, Italy
  • 2Regional Reference Center for Coagulation Disorders, Federico II University Hospital, Naples, Italy
Further Information

Publication History

Publication Date:
07 July 2010 (online)

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ABSTRACT

Disseminated intravascular coagulation (DIC) significantly contributes to the bleeding and thrombotic complications in patients with hematologic malignancies. As shown in other cancer settings, an underlying condition of activation of the coagulation system leading to a prothrombotic state of chronic or subclinical DIC is detectable. A variety of disease- or treatment-related factors may affect this condition, enhancing the risk of thrombosis or of bleeding and further triggering mechanisms of DIC in this setting. An overt DIC is diagnosed in ~15% of patients with acute leukemia, and bleeding manifestations prevail over thrombosis, with the highest and most harmful clinical impact in acute promyelocytic leukemia (APL). Pathogenic mechanisms include a series of intrinsic properties of malignant cells, able to directly activate the coagulation system or to stimulate prothrombotic effects by the host cells. Moreover, chemotherapy or concomitant infections play an important concurrent role. In this review the coagulation abnormalities, clinical manifestations, and the presently known pathophysiologic mechanisms of DIC in patients with hematologic malignancies are discussed, focusing on the most extensively studied condition of APL. Current approaches and open issues for the management and treatment of these patients are also reviewed.

KEYWORDS

Acute promyelocytic leukemia - bleeding - disseminated intravascular coagulation - hematologic malignancies - hypercoagulability - leukemia - thrombosis

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Massimo FranchiniM.D. 

Immunohematology and Transfusion Center, Department of Pathology and Laboratory Medicine

University Hospital, Via Gramsci, 14, 37124 Parma, Italy

Email: mfranchini@ao.pr.it