Abstract
Because of unexpected thrombotic complications (12 cases of cerebral infarction, 4 cases of deep vein thrombosis), a comprehensive study of the hemostatic system was undertaken in children receiving L-asp as part of ALL induction therapy. Antithrombin (AT), plasminogen (PLAS), fibrinogen (FIB), prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), factor V (F-V), and platelet count were studied weekly for 7 weeks (wks) in 12 children who received 9 doses of L-asp in wks 1, 2, and 3 of induction therapy. AT, PLAS, and FIB decreased progressively in all patients (pts) with minimums in 3rd wk of L-asp: mean of 12 pts: 70%, 52%, and 31% of normal, respectively; lowest individual levels: 52%, 33%, and 11%, respectively. Functional and immunological assays of AT and PLAS gave identical results. AT and PLAS were normal 2 wks after L-asp; FIB within 3 wks. PT, PTT, and TT were prolonged during wks 1-3 and normal or shortened by wks 5-6. Platelet production rebounded during wks 3-5 as marrow remission occurred (>400,000/μl in 10 of 12 pts). F-V rose steadily from 112% of normal, pretherapy, to 158% wk 5. These data demonstrate multiple abnormalities during ALL therapy; changes in AT, PLAS, FIB, PT, PTT, and TT are due to L-asp. The net effect is a tendency to thrombosis, which may be explained by deficiencies of AT and PLAS, rapidly rising platelet counts, and elevated F-V, despite concurrent severe hypofibrinogenemia.
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Priest, J., Edson, J. & Krivit, W. 855 HEMOSTATIC ABNORMALITIES AND THROMBOSIS DURING L-ASPARAGINASE (L-asp) THERAPY FOR ACUTE LYMPHOBLASTIC LEUKEMIA (ALL). Pediatr Res 15 (Suppl 4), 585 (1981). https://doi.org/10.1203/00006450-198104001-00880
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DOI: https://doi.org/10.1203/00006450-198104001-00880