Open AccessPB1734 THE ROLE OF ROTEM IN PREDICTING HEMORRHAGE AND HEMORRHAGIC EARLY DEATH RISK IN PATIENTS WITH ACUTE PROMYELOCYTIC LEUKEMIA
Author(s) -
Sabljic N.,
Mitrovic M.,
Kocica T.,
Virijevic M.,
Pravdic Z.,
Rajic J.,
Milosevic V.,
Vidovic A.,
Suvajdzic N.,
Tomin D.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000565444.34866.15
Subject(s) - medicine , acute promyelocytic leukemia , coagulopathy , fibrinogen , coagulation , hematology , platelet , gastroenterology , disseminated intravascular coagulation , coagulation testing , surgery , retinoic acid , biochemistry , chemistry , gene
Background: Hemorrhagic early death (HED), with reported rates between 5 and 26.52%, is a major impediment in the managing of acute promyelocytic leukemia (APL). It is well recognized that conventional coagulation parameters do not accurately predict the risk of major bleeding. There are limited data on the clinical utility of ROTEM and extended coagulation parameters for evaluation of coagulopathy in patients with APL. Aims: 1. To identify predictive value of ROTEM parameters for hemorrhage and HED. 2. To identify a correlation between ROTEM and conventional coagulation tests. Methods: We analyzed data in 19 newly diagnosed PML‐RARA positive patients (median age 37 years, range 18‐73; 11 female/8 male) managed in the Clinic of Hematology from 2016‐2019, with all‐trans retinoic acid combined with anthracyclines. HED was defined as death from hemorrhage from the first day of hospitalization up to the end of the induction treatment. The following parameters were evaluated as risk factors for bleeding and HED: WBC count, platelet count, fibrinogen level, PT, APTT, D dimer, ISTH DIC score, EXTEM (CT, CFT, alfa, A10, A20, ML), INTEM (CT, CFT, alfa, A10, A20, ML) and FIBTEM (CT, alfa, A10, A20, ML). Results: Hemorrhage and HED occurred in 15/19 (78.95%) and 2/19 (10.53%) patients, respectively. The median platelet count was 32 x 10 9 /L (range 4‐137 x 10 9 /L), fibrinogen level 3.3 g/L (range 1.31‐6.08 g/L), PT 64 % (range 39‐96 %) and APTT 26 s (range 20.5‐96 s). In our group of patients, EXTEM ML and INTEM ML, differ significantly from a normal range (P < 0.001). Predictors of hemorrhage were: EXTEM A10 (32 mm vs. 14 mm in patients without and with hemorrhage, P = 0.028), INTEM CFT (150 s vs. 1302 s, P = 0.05) and INTEM A10 (44 mm vs. 12.5 mm, P = 0.021). The parameters, significantly associated with HED, were: higher WBC (2.3 vs. 164.3 x 10 9 /L, P = 0.024), Sanz high‐risk APL (P = 0.045), EXTEM CT (114 s vs. 586.5 s, P = 0.024), EXTEM A10 (16 mm vs. 3.5 mm, P = 0.024), INTEM CT (191 s vs. 754 s, P = 0.027), INTEM A10 (15 mm vs. 6 mm, P = 0.027), FIBTEM CT (140 s vs. 723 s, P = 0.046) and FIBTEM A10 (6 mm vs. 1.5 mm, P = 0.023). Correlation between EXTEM A10 and platelet count (P = 0.033), INTEM ML and APTT (P = 0.024) was showen. There was no correlation between other parameters of INTEM and APTT, EXTEM and PT or any parameter of FIBTEM and fibrinogen. Summary/Conclusion: Our study showed that ROTEM parameters are predictive for both hemorrhage and HED in APL. No clear correlation between conventional tests and ROTEM was registered. Accordingly, new strategy that combines both, conventional test and ROTEM, would probably better evaluate hemostatic function in patients with APL, and would guide the transfusion support in prevention of HED.